Heights University Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN B12

Facility

$380.80

Service Code	HCPCS 82607
Hospital Charge Code	38472692
Hospital Revenue Code	301
Min. Negotiated Rate	$57.12
Max. Negotiated Rate	$57.12
Rate for Payer: Qualcare PPO/HMO/WC	$57.12

VITAMIN B12

Facility

$667.59

Service Code	HCPCS 82607
Hospital Charge Code	39888002
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

VITAMIN B12

Facility

$380.80

Service Code	HCPCS 82607
Hospital Charge Code	38472692
Hospital Revenue Code	301
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
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	$55.25
Rate for Payer: Cigna Commercial	$15.08
Rate for Payer: Cigna Medicare Advantage	$7.54
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.12
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.98
Rate for Payer: Wellcare Medicare Advantage	$15.08

VITAMIN B12

Facility

$667.59

Service Code	HCPCS 82607
Hospital Charge Code	39888002
Hospital Revenue Code	301
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
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	$55.25
Rate for Payer: Cigna Commercial	$15.08
Rate for Payer: Cigna Medicare Advantage	$7.54
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
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	$15.08
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.98
Rate for Payer: Wellcare Medicare Advantage	$15.08

VITAMIN B12 250MG TABLET

Facility

$4.00

Service Code	NDC 50268085315
Hospital Charge Code	606390158
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

VITAMIN B12 250MG TABLET

Facility

$4.00

Service Code	NDC 50268085315
Hospital Charge Code	606390158
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VITAMIN B12 BINDING CAPAC

Facility

$98.40

Service Code	HCPCS 82608
Hospital Charge Code	39900070
Hospital Revenue Code	301
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$14.76
Rate for Payer: Qualcare PPO/HMO/WC	$14.76

VITAMIN B12 BINDING CAPAC

Facility

$98.40

Service Code	HCPCS 82608
Hospital Charge Code	39900070
Hospital Revenue Code	301
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.40
Rate for Payer: Aetna Medicare Advantage	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.32
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	$52.47
Rate for Payer: Cigna Commercial	$14.32
Rate for Payer: Cigna Medicare Advantage	$7.16
Rate for Payer: Clover Medicare Advantage	$13.60
Rate for Payer: EmblemHealth Commercial	$42.96
Rate for Payer: Humana Medicare Advantage	$14.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.76
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.18
Rate for Payer: Wellcare Medicare Advantage	$14.32

VITAMIN B12 (CYANOCBALAMIN)

Facility

$309.95

Service Code	HCPCS 82607
Hospital Charge Code	3002763
Hospital Revenue Code	301
Min. Negotiated Rate	$46.49
Max. Negotiated Rate	$46.49
Rate for Payer: Qualcare PPO/HMO/WC	$46.49

VITAMIN B12 (CYANOCBALAMIN)

Facility

$309.95

Service Code	HCPCS 82607
Hospital Charge Code	3002763
Hospital Revenue Code	301
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$15.08
Rate for Payer: Cigna Medicare Advantage	$7.54
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
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	$55.25
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.98
Rate for Payer: Wellcare Medicare Advantage	$15.08

VITAMIN B12,SERUM

Facility

$103.60

Service Code	HCPCS 82607
Hospital Charge Code	39900069
Hospital Revenue Code	301
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$15.54
Rate for Payer: Qualcare PPO/HMO/WC	$15.54

VITAMIN B12,SERUM

Facility

$103.60

Service Code	HCPCS 82607
Hospital Charge Code	39900069
Hospital Revenue Code	301
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
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	$55.25
Rate for Payer: Cigna Commercial	$15.08
Rate for Payer: Cigna Medicare Advantage	$7.54
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.54
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.98
Rate for Payer: Wellcare Medicare Advantage	$15.08

VITAMIN B1 (ERYTHROCYTE TRANSK

Facility

$588.00

Service Code	HCPCS 84425
Hospital Charge Code	38472683
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$68.79
Rate for Payer: Aetna Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.79
Rate for Payer: Cigna Commercial	$21.23
Rate for Payer: Cigna Medicare Advantage	$10.62
Rate for Payer: Clover Medicare Advantage	$20.17
Rate for Payer: EmblemHealth Commercial	$63.69
Rate for Payer: Humana Medicare Advantage	$21.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.23
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.50
Rate for Payer: Wellcare Medicare Advantage	$21.23

VITAMIN B1 (ERYTHROCYTE TRANSK

Facility

$588.00

Service Code	HCPCS 84425
Hospital Charge Code	38472683
Hospital Revenue Code	301
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$88.20
Rate for Payer: Qualcare PPO/HMO/WC	$88.20

VITAMIN B1 (THIAMINE)

Facility

$192.85

Service Code	HCPCS 84425
Hospital Charge Code	3002748
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$68.79
Rate for Payer: Aetna Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.79
Rate for Payer: Cigna Commercial	$21.23
Rate for Payer: Cigna Medicare Advantage	$10.62
Rate for Payer: Clover Medicare Advantage	$20.17
Rate for Payer: EmblemHealth Commercial	$63.69
Rate for Payer: Humana Medicare Advantage	$21.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.23
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.50
Rate for Payer: Wellcare Medicare Advantage	$21.23

VITAMIN B1 (THIAMINE)

Facility

$192.85

Service Code	HCPCS 84425
Hospital Charge Code	3002748
Hospital Revenue Code	301
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

VITAMIN B1 (THIAMINE), B

Facility

$667.59

Service Code	HCPCS 84425
Hospital Charge Code	39900138
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

VITAMIN B1 (THIAMINE), B

Facility

$667.59

Service Code	HCPCS 84425
Hospital Charge Code	39900138
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$68.79
Rate for Payer: Aetna Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.79
Rate for Payer: Cigna Commercial	$21.23
Rate for Payer: Cigna Medicare Advantage	$10.62
Rate for Payer: Clover Medicare Advantage	$20.17
Rate for Payer: EmblemHealth Commercial	$63.69
Rate for Payer: Humana Medicare Advantage	$21.87
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	$21.23
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.50
Rate for Payer: Wellcare Medicare Advantage	$21.23

VITAMIN B2 (ERYTHROCYTE GLUT.R

Facility

$304.00

Service Code	HCPCS 84252
Hospital Charge Code	38472686
Hospital Revenue Code	301
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$45.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.60

VITAMIN B2 (ERYTHROCYTE GLUT.R

Facility

$304.00

Service Code	HCPCS 84252
Hospital Charge Code	38472686
Hospital Revenue Code	301
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.16
Rate for Payer: Cigna Commercial	$20.24
Rate for Payer: Cigna Medicare Advantage	$10.12
Rate for Payer: Clover Medicare Advantage	$19.23
Rate for Payer: EmblemHealth Commercial	$60.72
Rate for Payer: Humana Medicare Advantage	$20.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.45
Rate for Payer: Wellcare Medicare Advantage	$20.24

VITAMIN B2,PLASMA

Facility

$390.00

Service Code	HCPCS 84252
Hospital Charge Code	39900129
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN B2,PLASMA

Facility

$390.00

Service Code	HCPCS 84252
Hospital Charge Code	39900129
Hospital Revenue Code	301
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.16
Rate for Payer: Cigna Commercial	$20.24
Rate for Payer: Cigna Medicare Advantage	$10.12
Rate for Payer: Clover Medicare Advantage	$19.23
Rate for Payer: EmblemHealth Commercial	$60.72
Rate for Payer: Humana Medicare Advantage	$20.85
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	$20.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.45
Rate for Payer: Wellcare Medicare Advantage	$20.24

VITAMIN B2 (RIBOFLAVIN)

Facility

$179.25

Service Code	HCPCS 84252
Hospital Charge Code	3007754
Hospital Revenue Code	301
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.16
Rate for Payer: Cigna Commercial	$20.24
Rate for Payer: Cigna Medicare Advantage	$10.12
Rate for Payer: Clover Medicare Advantage	$19.23
Rate for Payer: EmblemHealth Commercial	$60.72
Rate for Payer: Humana Medicare Advantage	$20.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.45
Rate for Payer: Wellcare Medicare Advantage	$20.24

VITAMIN B2 (RIBOFLAVIN)

Facility

$179.25

Service Code	HCPCS 84252
Hospital Charge Code	3007754
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

VITAMIN B3

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39900518
Hospital Revenue Code	301
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.27
Rate for Payer: Aetna Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.51
Rate for Payer: Cigna Commercial	$17.06
Rate for Payer: Cigna Medicare Advantage	$8.53
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
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	$17.06
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.08
Rate for Payer: Wellcare Medicare Advantage	$17.06

Know your out-of-pocket cost for care.

All Charges