Heights University Hospital

All Charges

Charge

Type

Setting

Price

ASPIRIN TOLERANCE TEST

Facility

$116.25

Service Code	HCPCS 80329
Hospital Charge Code	3002392
Hospital Revenue Code	301
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.88
Rate for Payer: Aetna Medicare Advantage	$34.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.64
Rate for Payer: Cigna Commercial	$58.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.44
Rate for Payer: UnitedHealthcare Commercial	$114.00

ASSAY DIR MEAS FR ESTRADIOL

Facility

$123.17

Service Code	HCPCS 82681
Hospital Charge Code	401182681
Hospital Revenue Code	300
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$18.48
Rate for Payer: Qualcare PPO/HMO/WC	$18.48

ASSAY DIR MEAS FR ESTRADIOL

Facility

$123.17

Service Code	HCPCS 82681
Hospital Charge Code	401182681
Hospital Revenue Code	300
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	$20.91
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	$16.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.48
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

ASSAY GLUCOSE BLOOD QUANT

Facility

$390.00

Service Code	HCPCS 82947
Hospital Charge Code	401082947
Hospital Revenue Code	301
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.73
Rate for Payer: Aetna Medicare Advantage	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.40
Rate for Payer: Cigna Commercial	$3.93
Rate for Payer: Cigna Medicare Advantage	$1.97
Rate for Payer: Clover Medicare Advantage	$3.73
Rate for Payer: EmblemHealth Commercial	$11.79
Rate for Payer: Humana Medicare Advantage	$4.05
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	$3.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.17
Rate for Payer: Wellcare Medicare Advantage	$3.93

ASSAY GLUCOSE BLOOD QUANT

Facility

$390.00

Service Code	HCPCS 82947
Hospital Charge Code	401082947
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY HOMOVANILLIC ACID

Facility

$390.00

Service Code	HCPCS 83150
Hospital Charge Code	401083150A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY HOMOVANILLIC ACID

Facility

$390.00

Service Code	HCPCS 83150
Hospital Charge Code	401083150A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$72.61
Rate for Payer: Aetna Medicare Advantage	$22.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.41
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	$82.11
Rate for Payer: Cigna Commercial	$22.41
Rate for Payer: Cigna Medicare Advantage	$11.21
Rate for Payer: Clover Medicare Advantage	$21.29
Rate for Payer: EmblemHealth Commercial	$67.23
Rate for Payer: Humana Medicare Advantage	$23.08
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	$22.41
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.75
Rate for Payer: Wellcare Medicare Advantage	$22.41

ASSAY IGA/IGD/IGG/IGM EA

Facility

$115.30

Service Code	HCPCS 82784
Hospital Charge Code	401182784B
Hospital Revenue Code	302
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

ASSAY IGA/IGD/IGG/IGM EA

Facility

$115.30

Service Code	HCPCS 82784
Hospital Charge Code	401182784B
Hospital Revenue Code	302
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$17.30

ASSAY NEPHELOMETRY NOT SPEC

Facility

$390.00

Service Code	HCPCS 83883
Hospital Charge Code	401083883
Hospital Revenue Code	301
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$165.64
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.83
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: Cigna Medicare Advantage	$6.80
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
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	$13.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.42
Rate for Payer: Wellcare Medicare Advantage	$13.60

ASSAY NEPHELOMETRY NOT SPEC

Facility

$390.00

Service Code	HCPCS 83883
Hospital Charge Code	401083883
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF ANDROSTENEDIONE

Facility

$390.00

Service Code	HCPCS 82157
Hospital Charge Code	401182157
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF ANDROSTENEDIONE

Facility

$390.00

Service Code	HCPCS 82157
Hospital Charge Code	401182157
Hospital Revenue Code	301
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$94.87
Rate for Payer: Aetna Medicare Advantage	$29.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.28
Rate for Payer: Cigna Commercial	$29.28
Rate for Payer: Cigna Medicare Advantage	$14.64
Rate for Payer: Clover Medicare Advantage	$27.82
Rate for Payer: EmblemHealth Commercial	$87.84
Rate for Payer: Humana Medicare Advantage	$30.16
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	$29.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.04
Rate for Payer: Wellcare Medicare Advantage	$29.28

ASSAY OF ARSENIC

Facility

$390.00

Service Code	HCPCS 82175
Hospital Charge Code	401082175
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF ARSENIC

Facility

$390.00

Service Code	HCPCS 82175
Hospital Charge Code	401082175
Hospital Revenue Code	301
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$61.46
Rate for Payer: Aetna Medicare Advantage	$18.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.51
Rate for Payer: Cigna Commercial	$18.97
Rate for Payer: Cigna Medicare Advantage	$9.48
Rate for Payer: Clover Medicare Advantage	$18.02
Rate for Payer: EmblemHealth Commercial	$56.91
Rate for Payer: Humana Medicare Advantage	$19.54
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	$18.97
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.11
Rate for Payer: Wellcare Medicare Advantage	$18.97

ASSAY OF BLOOD FATTY ACIDS

Facility

$93.85

Service Code	HCPCS 82725
Hospital Charge Code	401382725B
Hospital Revenue Code	306
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$14.08

ASSAY OF BLOOD FATTY ACIDS

Facility

$93.85

Service Code	HCPCS 82725
Hospital Charge Code	401382725B
Hospital Revenue Code	306
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.81
Rate for Payer: Aetna Medicare Advantage	$18.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.77
Rate for Payer: Cigna Commercial	$18.77
Rate for Payer: Cigna Medicare Advantage	$9.38
Rate for Payer: Clover Medicare Advantage	$17.83
Rate for Payer: EmblemHealth Commercial	$56.31
Rate for Payer: Humana Medicare Advantage	$19.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.08
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.90
Rate for Payer: Wellcare Medicare Advantage	$18.77

ASSAY OF CADMIUM

Facility

$390.00

Service Code	HCPCS 82300
Hospital Charge Code	401082300
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF CADMIUM

Facility

$390.00

Service Code	HCPCS 82300
Hospital Charge Code	401082300
Hospital Revenue Code	301
Min. Negotiated Rate	$11.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$76.59
Rate for Payer: Aetna Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.62
Rate for Payer: Cigna Commercial	$23.64
Rate for Payer: Cigna Medicare Advantage	$11.82
Rate for Payer: Clover Medicare Advantage	$22.46
Rate for Payer: EmblemHealth Commercial	$70.92
Rate for Payer: Humana Medicare Advantage	$24.35
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	$23.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.06
Rate for Payer: Wellcare Medicare Advantage	$23.64

ASSAY OF FREE TESTOSTERONE

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	401184402
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF FREE TESTOSTERONE

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	401184402
Hospital Revenue Code	301
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$82.52
Rate for Payer: Aetna Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.32
Rate for Payer: Cigna Commercial	$25.47
Rate for Payer: Cigna Medicare Advantage	$12.73
Rate for Payer: Clover Medicare Advantage	$24.20
Rate for Payer: EmblemHealth Commercial	$76.41
Rate for Payer: Humana Medicare Advantage	$26.23
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	$25.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.00
Rate for Payer: Wellcare Medicare Advantage	$25.47

ASSAY OF LEAD

Facility

$390.00

Service Code	HCPCS 83655
Hospital Charge Code	401083655
Hospital Revenue Code	301
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.24
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
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	$44.37
Rate for Payer: Cigna Commercial	$12.11
Rate for Payer: Cigna Medicare Advantage	$6.05
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
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	$12.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.84
Rate for Payer: Wellcare Medicare Advantage	$12.11

ASSAY OF LEAD

Facility

$390.00

Service Code	HCPCS 83655
Hospital Charge Code	401083655
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF MERCURY

Facility

$390.00

Service Code	HCPCS 83825
Hospital Charge Code	401083825
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF MERCURY

Facility

$390.00

Service Code	HCPCS 83825
Hospital Charge Code	401083825
Hospital Revenue Code	301
Min. Negotiated Rate	$8.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.68
Rate for Payer: Aetna Medicare Advantage	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.58
Rate for Payer: Cigna Commercial	$16.26
Rate for Payer: Cigna Medicare Advantage	$8.13
Rate for Payer: Clover Medicare Advantage	$15.45
Rate for Payer: EmblemHealth Commercial	$48.78
Rate for Payer: Humana Medicare Advantage	$16.75
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	$16.26
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.24
Rate for Payer: Wellcare Medicare Advantage	$16.26

Know your out-of-pocket cost for care.

All Charges