Heights University Hospital

All Charges

Charge

Type

Setting

Price

VOLUME RESPIRATION***

Facility

$439.00

Service Code	HCPCS 94656
Hospital Charge Code	9500182
Hospital Revenue Code	419
Min. Negotiated Rate	$57.07
Max. Negotiated Rate	$1,004.00
Rate for Payer: Aetna Commercial	$131.70
Rate for Payer: Aetna Medicare Advantage	$131.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.94
Rate for Payer: Cigna Commercial	$219.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.07
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.85
Rate for Payer: UnitedHealthcare Commercial	$1,004.00

VOLUME TIMED MEASUREMENT

Facility

$43.00

Service Code	HCPCS 81050
Hospital Charge Code	38472703
Hospital Revenue Code	307
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

VOLUME TIMED MEASUREMENT

Facility

$43.00

Service Code	HCPCS 81050
Hospital Charge Code	38472703
Hospital Revenue Code	307
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.79
Rate for Payer: Aetna Medicare Advantage	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.34
Rate for Payer: Cigna Commercial	$3.64
Rate for Payer: Cigna Medicare Advantage	$1.82
Rate for Payer: Clover Medicare Advantage	$3.46
Rate for Payer: EmblemHealth Commercial	$10.92
Rate for Payer: Humana Medicare Advantage	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.86
Rate for Payer: Wellcare Medicare Advantage	$3.64

VON WILLEBRAND 1

Facility

$245.65

Service Code	HCPCS 85240
Hospital Charge Code	3036011A
Hospital Revenue Code	300
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$36.85
Rate for Payer: Qualcare PPO/HMO/WC	$36.85

VON WILLEBRAND 1

Facility

$245.65

Service Code	HCPCS 85240
Hospital Charge Code	3036011A
Hospital Revenue Code	300
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.00
Rate for Payer: Aetna Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.59
Rate for Payer: Cigna Commercial	$17.90
Rate for Payer: Cigna Medicare Advantage	$8.95
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.97
Rate for Payer: Wellcare Medicare Advantage	$17.90

VON WILLEBRAND 2

Facility

$230.40

Service Code	HCPCS 85245
Hospital Charge Code	3036011B
Hospital Revenue Code	300
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$34.56
Rate for Payer: Qualcare PPO/HMO/WC	$34.56

VON WILLEBRAND 2

Facility

$230.40

Service Code	HCPCS 85245
Hospital Charge Code	3036011B
Hospital Revenue Code	300
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.56
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

VON WILLEBRAND 3

Facility

$230.40

Service Code	HCPCS 85246
Hospital Charge Code	3036011C
Hospital Revenue Code	300
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.56
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

VON WILLEBRAND 3

Facility

$230.40

Service Code	HCPCS 85246
Hospital Charge Code	3036011C
Hospital Revenue Code	300
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$34.56
Rate for Payer: Qualcare PPO/HMO/WC	$34.56

VON WILLEBRAND COMP PANEL I

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	3990128A
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL I

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	3990128A
Hospital Revenue Code	305
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.00
Rate for Payer: Aetna Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.59
Rate for Payer: Cigna Commercial	$17.90
Rate for Payer: Cigna Medicare Advantage	$8.95
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
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	$17.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.97
Rate for Payer: Wellcare Medicare Advantage	$17.90

VON WILLEBRAND COMP PANEL II

Facility

$390.00

Service Code	HCPCS 85245
Hospital Charge Code	3990128B
Hospital Revenue Code	305
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
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	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

VON WILLEBRAND COMP PANEL II

Facility

$390.00

Service Code	HCPCS 85245
Hospital Charge Code	3990128B
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL III

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	3990128C
Hospital Revenue Code	305
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
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	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

VON WILLEBRAND COMP PANEL III

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	3990128C
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL IV

Facility

$390.00

Service Code	HCPCS 85247
Hospital Charge Code	3990128D
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL IV

Facility

$390.00

Service Code	HCPCS 85247
Hospital Charge Code	3990128D
Hospital Revenue Code	305
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
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	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

VON WILLEBRAND COMP PANEL V

Facility

$390.00

Service Code	HCPCS 85730
Hospital Charge Code	3990128E
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL V

Facility

$390.00

Service Code	HCPCS 85730
Hospital Charge Code	3990128E
Hospital Revenue Code	305
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.47
Rate for Payer: Aetna Medicare Advantage	$6.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.01
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	$22.02
Rate for Payer: Cigna Commercial	$6.01
Rate for Payer: Cigna Medicare Advantage	$3.00
Rate for Payer: Clover Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$6.19
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	$6.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.37
Rate for Payer: Wellcare Medicare Advantage	$6.01

VON WILLEBRAND FACTOR PRO

Facility

$157.70

Service Code	HCPCS 85397
Hospital Charge Code	39900172
Hospital Revenue Code	305
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$99.99
Rate for Payer: Aetna Medicare Advantage	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.07
Rate for Payer: Cigna Commercial	$30.86
Rate for Payer: Cigna Medicare Advantage	$15.43
Rate for Payer: Clover Medicare Advantage	$29.32
Rate for Payer: EmblemHealth Commercial	$92.58
Rate for Payer: Humana Medicare Advantage	$31.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.66
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$32.71
Rate for Payer: Wellcare Medicare Advantage	$30.86

VON WILLEBRAND FACTOR PRO

Facility

$157.70

Service Code	HCPCS 85397
Hospital Charge Code	39900172
Hospital Revenue Code	305
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$23.66
Rate for Payer: Qualcare PPO/HMO/WC	$23.66

VON WILLEBRANDS FACTOR ANTG

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38479463
Hospital Revenue Code	305
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

VON WILLEBRANDS FACTOR ANTG

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38479463
Hospital Revenue Code	305
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

VON WILLEBRANDS FACTOR ANTIGEN

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38478073
Hospital Revenue Code	305
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

VON WILLEBRANDS FACTOR ANTIGEN

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38478073
Hospital Revenue Code	305
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

Know your out-of-pocket cost for care.

All Charges