Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMUR NONPOROUS SZ 5

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672551
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

FEMUR NONPOROUS SZ 6

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672552
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMUR NONPOROUS SZ 6

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672552
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

FEMUR POROUS 9 LEFT

Facility

$18,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270692261
Hospital Revenue Code	278
Min. Negotiated Rate	$455.49
Max. Negotiated Rate	$9,450.00
Rate for Payer: Aetna Commercial	$7,182.00
Rate for Payer: Aetna Medicare Advantage	$5,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,819.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,819.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,819.50
Rate for Payer: Cigna Commercial	$9,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,573.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,158.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,835.00
Rate for Payer: UnitedHealthcare Community & State	$455.49
Rate for Payer: Wellpoint Medicaid Managed Care	$500.85

FEMUR POROUS 9 LEFT

Facility

$18,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270692261
Hospital Revenue Code	278
Min. Negotiated Rate	$2,835.00
Max. Negotiated Rate	$4,573.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,573.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,158.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,835.00

FEMUR PORUS MAXM RGT 65 140052

Facility

$10,128.00

Hospital Charge Code	270612922
Hospital Revenue Code	278
Min. Negotiated Rate	$244.08
Max. Negotiated Rate	$5,064.00
Rate for Payer: Aetna Commercial	$3,848.64
Rate for Payer: Aetna Medicare Advantage	$3,038.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,582.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,582.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,025.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,582.64
Rate for Payer: Cigna Commercial	$5,064.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,450.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,228.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,519.20
Rate for Payer: UnitedHealthcare Community & State	$244.08
Rate for Payer: Wellpoint Medicaid Managed Care	$268.39

FEMUR PORUS MAXM RGT 65 140052

Facility

$10,128.00

Hospital Charge Code	270612922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,519.20
Max. Negotiated Rate	$2,450.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,025.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,450.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,228.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,519.20

FEMUR PSN NARROW RT SZ10

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693756
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

FEMUR PSN NARROW RT SZ10

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693756
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

FEMUR PS NONPOROUS 6L EMPOWR

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692550
Hospital Revenue Code	278
Min. Negotiated Rate	$278.36
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Community & State	$278.36
Rate for Payer: Wellpoint Medicaid Managed Care	$306.07

FEMUR PS NONPOROUS 6L EMPOWR

Facility

$11,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692550
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FEMUR PSN PS POR CCR STD SZ 5

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270698039
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

FEMUR PSN PS POR CCR STD SZ 5

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270698039
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

FEMUR RIGHT 3CM INTLK

Facility

$38,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270673537
Hospital Revenue Code	278
Min. Negotiated Rate	$5,769.00
Max. Negotiated Rate	$9,307.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,692.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,307.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,461.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,769.00

FEMUR RIGHT 3CM INTLK

Facility

$38,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270673537
Hospital Revenue Code	278
Min. Negotiated Rate	$926.89
Max. Negotiated Rate	$19,230.00
Rate for Payer: Aetna Commercial	$14,614.80
Rate for Payer: Aetna Medicare Advantage	$11,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,807.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,807.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,692.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,807.30
Rate for Payer: Cigna Commercial	$19,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,307.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,461.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,769.00
Rate for Payer: UnitedHealthcare Community & State	$926.89
Rate for Payer: Wellpoint Medicaid Managed Care	$1,019.19

FEMUR SPHERE CEMENTED L SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681246
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMUR SPHERE CEMENTED L SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681246
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMUR SPHERE CEMENTED L SZ 6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681286
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMUR SPHERE CEMENTED L SZ 6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681286
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMUR SPHERE LEFT S3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683108
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMUR SPHERE LEFT S3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683108
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMUR SPHERE RIGHT S1 +

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681358
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMUR SPHERE RIGHT S1 +

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681358
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMUR STANDARD PORUS SZ10 LEFT

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693962
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

FEMUR STANDARD PORUS SZ10 LEFT

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693962
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

Know your out-of-pocket cost for care.

All Charges