Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$32,810.54

Service Code	MSDRG 197
Min. Negotiated Rate	$9,990.39
Max. Negotiated Rate	$32,810.54
Rate for Payer: Aetna Commercial	$22,801.92
Rate for Payer: Aetna Medicare Advantage	$32,810.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,516.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,261.00
Rate for Payer: Cigna Commercial	$17,761.46
Rate for Payer: Cigna Medicare Advantage	$10,516.20
Rate for Payer: Clover Medicare Advantage	$9,990.39
Rate for Payer: EmblemHealth Commercial	$31,548.60
Rate for Payer: Humana Medicare Advantage	$10,831.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,516.20
Rate for Payer: Oxford Commercial	$12,765.40
Rate for Payer: UnitedHealthcare Commercial	$22,384.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,516.20
Rate for Payer: Wellcare Medicare Advantage	$10,516.20

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$63,131.52

Service Code	MSDRG 196
Min. Negotiated Rate	$19,222.74
Max. Negotiated Rate	$63,131.52
Rate for Payer: Aetna Commercial	$43,635.89
Rate for Payer: Aetna Medicare Advantage	$63,131.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,195.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,195.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,234.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,195.90
Rate for Payer: Cigna Commercial	$35,317.06
Rate for Payer: Cigna Medicare Advantage	$20,234.46
Rate for Payer: Clover Medicare Advantage	$19,222.74
Rate for Payer: EmblemHealth Commercial	$60,703.38
Rate for Payer: Humana Medicare Advantage	$20,841.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,234.46
Rate for Payer: Oxford Commercial	$25,382.84
Rate for Payer: UnitedHealthcare Commercial	$44,509.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,234.46
Rate for Payer: Wellcare Medicare Advantage	$20,234.46

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$25,282.83

Service Code	MSDRG 198
Min. Negotiated Rate	$7,698.30
Max. Negotiated Rate	$25,282.83
Rate for Payer: Aetna Commercial	$17,629.52
Rate for Payer: Aetna Medicare Advantage	$25,282.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,103.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,143.58
Rate for Payer: Cigna Commercial	$13,402.97
Rate for Payer: Cigna Medicare Advantage	$8,103.47
Rate for Payer: Clover Medicare Advantage	$7,698.30
Rate for Payer: EmblemHealth Commercial	$24,310.41
Rate for Payer: Humana Medicare Advantage	$8,346.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,103.47
Rate for Payer: Oxford Commercial	$9,632.89
Rate for Payer: UnitedHealthcare Commercial	$16,891.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,103.47
Rate for Payer: Wellcare Medicare Advantage	$8,103.47

INTERVERT BODY FUSION DEV 15X1

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705401
Hospital Revenue Code	278
Min. Negotiated Rate	$469.95
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$469.95
Rate for Payer: Wellpoint Medicaid Managed Care	$516.75

INTERVERT BODY FUSION DEV 15X1

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705401
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

INTERVERT BODY FUSION DEV 17.5

Facility

$15,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270706103
Hospital Revenue Code	278
Min. Negotiated Rate	$373.55
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$5,890.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00
Rate for Payer: UnitedHealthcare Community & State	$373.55
Rate for Payer: Wellpoint Medicaid Managed Care	$410.75

INTERVERT BODY FUSION DEV 17.5

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270706250
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERVERT BODY FUSION DEV 17.5

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270706250
Hospital Revenue Code	278
Min. Negotiated Rate	$373.55
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$5,890.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00
Rate for Payer: UnitedHealthcare Community & State	$373.55
Rate for Payer: Wellpoint Medicaid Managed Care	$410.75

INTERVERT BODY FUSION DEV 17.5

Facility

$15,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270706103
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERVERTEBRAL BODY FUSION DEV

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704543
Hospital Revenue Code	278
Min. Negotiated Rate	$373.55
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$5,890.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00
Rate for Payer: UnitedHealthcare Community & State	$373.55
Rate for Payer: Wellpoint Medicaid Managed Care	$410.75

INTERVERTEBRAL BODY FUSION DEV

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704543
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTESTINAL OBSTRUCTION

Facility

$5,863.92

Service Code	APR-DRG 2471
Min. Negotiated Rate	$5,748.94
Max. Negotiated Rate	$5,863.92
Rate for Payer: UnitedHealthcare Community & State	$5,748.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,863.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5,748.94

INTESTINAL OBSTRUCTION

Facility

$11,301.45

Service Code	APR-DRG 2473
Min. Negotiated Rate	$11,079.85
Max. Negotiated Rate	$11,301.45
Rate for Payer: UnitedHealthcare Community & State	$11,079.85
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,301.45
Rate for Payer: Wellpoint Medicaid Managed Care	$11,079.85

INTESTINAL OBSTRUCTION

Facility

$20,710.79

Service Code	APR-DRG 2474
Min. Negotiated Rate	$20,304.70
Max. Negotiated Rate	$20,710.79
Rate for Payer: UnitedHealthcare Community & State	$20,304.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,710.79
Rate for Payer: Wellpoint Medicaid Managed Care	$20,304.70

INTESTINAL OBSTRUCTION

Facility

$7,537.70

Service Code	APR-DRG 2472
Min. Negotiated Rate	$7,389.90
Max. Negotiated Rate	$7,537.70
Rate for Payer: UnitedHealthcare Community & State	$7,389.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,537.70
Rate for Payer: Wellpoint Medicaid Managed Care	$7,389.90

INTL HOSP OR BIRTH CARE E&M NB

Facility

$478.30

Service Code	HCPCS 99460
Hospital Charge Code	93950215
Hospital Revenue Code	510
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$570.95
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.95
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.49
Rate for Payer: Qualcare PPO/HMO/WC	$71.75
Rate for Payer: UnitedHealthcare Community & State	$11.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

INTL HOSP OR BIRTH CARE E&M NB

Facility

$478.30

Service Code	HCPCS 99460
Hospital Charge Code	93950215
Hospital Revenue Code	510
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$71.75
Rate for Payer: Qualcare PPO/HMO/WC	$71.75

INTL PREVENTIVE PHYSICAL EXAM

Facility

$500.45

Service Code	HCPCS G0402
Hospital Charge Code	87502675
Hospital Revenue Code	770
Min. Negotiated Rate	$75.07
Max. Negotiated Rate	$75.07
Rate for Payer: Qualcare PPO/HMO/WC	$75.07

INTL PREVENTIVE PHYSICAL EXAM

Facility

$500.45

Service Code	HCPCS G0402
Hospital Charge Code	83652529
Hospital Revenue Code	770
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$570.95
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.95
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.13
Rate for Payer: Oxford Commercial	$100.09
Rate for Payer: Qualcare PPO/HMO/WC	$75.07
Rate for Payer: UnitedHealthcare Commercial	$100.09
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.26

INTL PREVENTIVE PHYSICAL EXAM

Facility

$500.45

Service Code	HCPCS G0402
Hospital Charge Code	83652529
Hospital Revenue Code	770
Min. Negotiated Rate	$75.07
Max. Negotiated Rate	$75.07
Rate for Payer: Qualcare PPO/HMO/WC	$75.07

INTL PREVENTIVE PHYSICAL EXAM

Facility

$500.45

Service Code	HCPCS G0402
Hospital Charge Code	87502675
Hospital Revenue Code	770
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$570.95
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.95
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.13
Rate for Payer: Oxford Commercial	$100.09
Rate for Payer: Qualcare PPO/HMO/WC	$75.07
Rate for Payer: UnitedHealthcare Commercial	$100.09
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.26

INTMD RPR N-HF/GENIT 2.5cm/<

Facility

$1,457.75

Service Code	HCPCS 12041
Hospital Charge Code	16000357
Hospital Revenue Code	360
Min. Negotiated Rate	$35.13
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.32
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$218.66
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$35.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

INTMD RPR N-HF/GENIT 2.5cm/<

Facility

$1,457.75

Service Code	HCPCS 12041
Hospital Charge Code	16000357
Hospital Revenue Code	360
Min. Negotiated Rate	$218.66
Max. Negotiated Rate	$218.66
Rate for Payer: Qualcare PPO/HMO/WC	$218.66

INTMD WND REPAIR N-HF/GENIT

Facility

$1,457.75

Service Code	HCPCS 12042
Hospital Charge Code	16000260
Hospital Revenue Code	360
Min. Negotiated Rate	$218.66
Max. Negotiated Rate	$218.66
Rate for Payer: Qualcare PPO/HMO/WC	$218.66

INTMD WND REPAIR N-HF/GENIT

Facility

$1,457.75

Service Code	HCPCS 12042
Hospital Charge Code	16000260
Hospital Revenue Code	360
Min. Negotiated Rate	$35.13
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.32
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$218.66
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$35.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

Know your out-of-pocket cost for care.

All Charges