Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROTEIN, TOTAL, CSF

Facility

$390.00

Service Code	HCPCS 84157
Hospital Charge Code	3030020
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROTEIN, TOTAL, CSF

Facility

$390.00

Service Code	HCPCS 84157
Hospital Charge Code	3030020
Hospital Revenue Code	301
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$15,880.57
Rate for Payer: Aetna Better Health Medicaid	$15,569.19
Rate for Payer: Aetna Commercial	$12.96
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.66
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: Cigna Medicare Advantage	$2.00
Rate for Payer: Clover Medicare Advantage	$3.80
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Humana Medicare Advantage	$4.12
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	$4.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.24
Rate for Payer: Wellcare Medicare Advantage	$4.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57

PROTEIN,TOTAL CSF

Facility

$116.00

Service Code	HCPCS 84157
Hospital Charge Code	38479008
Hospital Revenue Code	301
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

PROTEIN,TOTAL CSF

Facility

$116.00

Service Code	HCPCS 84157
Hospital Charge Code	38479008
Hospital Revenue Code	301
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$15,880.57
Rate for Payer: Aetna Better Health Medicaid	$15,569.19
Rate for Payer: Aetna Commercial	$12.96
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.66
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: Cigna Medicare Advantage	$2.00
Rate for Payer: Clover Medicare Advantage	$3.80
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Humana Medicare Advantage	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.24
Rate for Payer: Wellcare Medicare Advantage	$4.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57

PROTEIN,TOTAL,SYNOVIAL FL

Facility

$390.00

Service Code	HCPCS 84157
Hospital Charge Code	39990018EX
Hospital Revenue Code	301
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$15,880.57
Rate for Payer: Aetna Better Health Medicaid	$15,569.19
Rate for Payer: Aetna Commercial	$12.96
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.66
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: Cigna Medicare Advantage	$2.00
Rate for Payer: Clover Medicare Advantage	$3.80
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Humana Medicare Advantage	$4.12
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	$4.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.24
Rate for Payer: Wellcare Medicare Advantage	$4.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57

PROTEIN,TOTAL,SYNOVIAL FL

Facility

$390.00

Service Code	HCPCS 84157
Hospital Charge Code	39990018EX
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROTEIN,TOTAL,SYNOVIAL FL I

Facility

$25.20

Service Code	HCPCS 84155
Hospital Charge Code	39990018A
Hospital Revenue Code	301
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.89
Rate for Payer: Aetna Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.45
Rate for Payer: Cigna Commercial	$3.67
Rate for Payer: Cigna Medicare Advantage	$1.83
Rate for Payer: Clover Medicare Advantage	$3.49
Rate for Payer: EmblemHealth Commercial	$11.01
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.89
Rate for Payer: Wellcare Medicare Advantage	$3.67

PROTEIN,TOTAL,SYNOVIAL FL I

Facility

$25.20

Service Code	HCPCS 84155
Hospital Charge Code	39990018A
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

PROTEIN,TOTAL,SYNOVIAL FL II

Facility

$25.20

Service Code	HCPCS 84157
Hospital Charge Code	39990018B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$15,880.57
Rate for Payer: Aetna Better Health Medicaid	$15,569.19
Rate for Payer: Aetna Commercial	$12.96
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.66
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: Cigna Medicare Advantage	$2.00
Rate for Payer: Clover Medicare Advantage	$3.80
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Humana Medicare Advantage	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.24
Rate for Payer: Wellcare Medicare Advantage	$4.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57

PROTEIN,TOTAL,SYNOVIAL FL II

Facility

$25.20

Service Code	HCPCS 84157
Hospital Charge Code	39990018B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

PROTEIN, TOTAL, URINE

Facility

$61.70

Service Code	HCPCS 84156
Hospital Charge Code	3002243
Hospital Revenue Code	301
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.89
Rate for Payer: Aetna Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.45
Rate for Payer: Cigna Commercial	$3.67
Rate for Payer: Cigna Medicare Advantage	$1.83
Rate for Payer: Clover Medicare Advantage	$3.49
Rate for Payer: EmblemHealth Commercial	$11.01
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.26
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.89
Rate for Payer: Wellcare Medicare Advantage	$3.67

PROTEIN, TOTAL, URINE

Facility

$61.70

Service Code	HCPCS 84156
Hospital Charge Code	3002243
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$9.26
Rate for Payer: Qualcare PPO/HMO/WC	$9.26

PROTEIN WESTERN BLOT BODY FLUI

Facility

$120.60

Service Code	HCPCS 84181
Hospital Charge Code	38477143
Hospital Revenue Code	301
Min. Negotiated Rate	$18.09
Max. Negotiated Rate	$18.09
Rate for Payer: Qualcare PPO/HMO/WC	$18.09

PROTEIN WESTERN BLOT BODY FLUI

Facility

$120.60

Service Code	HCPCS 84181
Hospital Charge Code	38477143
Hospital Revenue Code	301
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
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	$62.40
Rate for Payer: Cigna Commercial	$17.03
Rate for Payer: Cigna Medicare Advantage	$8.52
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.05
Rate for Payer: Wellcare Medicare Advantage	$17.03

PROTEIN WESTERN BLOT EACH(X6)

Facility

$732.08

Service Code	HCPCS 84182
Hospital Charge Code	40119477A
Hospital Revenue Code	301
Min. Negotiated Rate	$109.81
Max. Negotiated Rate	$109.81
Rate for Payer: Qualcare PPO/HMO/WC	$109.81

PROTEIN WESTERN BLOT EACH(X6)

Facility

$732.08

Service Code	HCPCS 84182
Hospital Charge Code	40119477A
Hospital Revenue Code	301
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$94.64
Rate for Payer: Aetna Medicare Advantage	$29.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.21
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	$107.03
Rate for Payer: Cigna Commercial	$29.21
Rate for Payer: Cigna Medicare Advantage	$14.61
Rate for Payer: Clover Medicare Advantage	$27.75
Rate for Payer: EmblemHealth Commercial	$87.63
Rate for Payer: Humana Medicare Advantage	$30.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.81
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.21
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$30.96
Rate for Payer: Wellcare Medicare Advantage	$29.21

PROT ELECTROPHORESIS,UR

Facility

$126.30

Service Code	HCPCS 84166
Hospital Charge Code	38479109
Hospital Revenue Code	301
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.77
Rate for Payer: Aetna Medicare Advantage	$17.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.33
Rate for Payer: Cigna Commercial	$17.83
Rate for Payer: Cigna Medicare Advantage	$8.91
Rate for Payer: Clover Medicare Advantage	$16.94
Rate for Payer: EmblemHealth Commercial	$53.49
Rate for Payer: Humana Medicare Advantage	$18.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.83
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.90
Rate for Payer: Wellcare Medicare Advantage	$17.83

PROT ELECTROPHORESIS,UR

Facility

$126.30

Service Code	HCPCS 84166
Hospital Charge Code	38479109
Hospital Revenue Code	301
Min. Negotiated Rate	$18.95
Max. Negotiated Rate	$18.95
Rate for Payer: Qualcare PPO/HMO/WC	$18.95

PROTHESIS PENILE AMBICOR 18 CM

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270686106
Hospital Revenue Code	278
Min. Negotiated Rate	$10,443.75
Max. Negotiated Rate	$16,849.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75

PROTHESIS PENILE AMBICOR 18 CM

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270686106
Hospital Revenue Code	278
Min. Negotiated Rate	$10,443.75
Max. Negotiated Rate	$34,812.50
Rate for Payer: Aetna Commercial	$20,887.50
Rate for Payer: Aetna Medicare Advantage	$20,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,754.38
Rate for Payer: Cigna Commercial	$34,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75

PROTHROMBIN GENE ANALYSIS

Facility

$390.00

Service Code	HCPCS 81240
Hospital Charge Code	39900016
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROTHROMBIN GENE ANALYSIS

Facility

$111.00

Hospital Charge Code	3002286A
Hospital Revenue Code	301
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.30
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

PROTHROMBIN GENE ANALYSIS

Facility

$390.00

Service Code	HCPCS 81240
Hospital Charge Code	39900016
Hospital Revenue Code	310
Min. Negotiated Rate	$32.84
Max. Negotiated Rate	$240.69
Rate for Payer: Aetna Commercial	$212.84
Rate for Payer: Aetna Medicare Advantage	$65.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$65.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.69
Rate for Payer: Cigna Commercial	$65.69
Rate for Payer: Cigna Medicare Advantage	$32.84
Rate for Payer: Clover Medicare Advantage	$62.41
Rate for Payer: EmblemHealth Commercial	$197.07
Rate for Payer: Humana Medicare Advantage	$67.66
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	$65.69
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$69.63
Rate for Payer: Wellcare Medicare Advantage	$65.69

PROTHROMBIN GENE ANALYSIS

Facility

$111.00

Hospital Charge Code	3002286A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

PROTHROMBIN TIME (PT)

Facility

$176.40

Service Code	HCPCS 85610
Hospital Charge Code	38478008
Hospital Revenue Code	305
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: Aetna Medicare Advantage	$4.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.29
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	$15.72
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: Cigna Medicare Advantage	$2.15
Rate for Payer: Clover Medicare Advantage	$4.08
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.46
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.29
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.55
Rate for Payer: Wellcare Medicare Advantage	$4.29

Know your out-of-pocket cost for care.

All Charges