Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM THYROID METS IMA WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78018
Hospital Charge Code	4500902
Hospital Revenue Code	341
Min. Negotiated Rate	$189.73
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM THYROID METS IMA WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78018
Hospital Charge Code	4500902
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM THYROID METS UPTAKE

Facility

$655.25

Service Code	HCPCS 78020
Hospital Charge Code	4500904
Hospital Revenue Code	341
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$249.00
Rate for Payer: Aetna Medicare Advantage	$196.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.09
Rate for Payer: Cigna Commercial	$327.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.57
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.29
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: Wellpoint Medicaid Managed Care	$17.36

NM THYROID METS UPTAKE

Facility

$655.25

Service Code	HCPCS 78020
Hospital Charge Code	4500904
Hospital Revenue Code	341
Min. Negotiated Rate	$98.29
Max. Negotiated Rate	$98.29
Rate for Payer: Qualcare PPO/HMO/WC	$98.29

NM THYROID SCAN

Facility

$528.85

Hospital Charge Code	4500047
Hospital Revenue Code	341
Min. Negotiated Rate	$79.33
Max. Negotiated Rate	$79.33
Rate for Payer: Qualcare PPO/HMO/WC	$79.33

NM THYROID SCAN

Facility

$528.85

Hospital Charge Code	4500047
Hospital Revenue Code	341
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$200.96
Rate for Payer: Aetna Medicare Advantage	$158.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.86
Rate for Payer: Cigna Commercial	$264.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.33
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$12.75
Rate for Payer: Wellpoint Medicaid Managed Care	$14.01

NM-THYROID UPTAKE ONLY

Facility

$688.00

Service Code	HCPCS 78000
Hospital Charge Code	4508001
Hospital Revenue Code	341
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$103.20
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

NM-THYROID UPTAKE ONLY

Facility

$688.00

Service Code	HCPCS 78000
Hospital Charge Code	4508001
Hospital Revenue Code	341
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$261.44
Rate for Payer: Aetna Medicare Advantage	$206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.44
Rate for Payer: Cigna Commercial	$344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$16.58
Rate for Payer: Wellpoint Medicaid Managed Care	$18.23

NM THYROID UPTAKE; SGL

Facility

$433.65

Hospital Charge Code	4500039
Hospital Revenue Code	341
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$164.79
Rate for Payer: Aetna Medicare Advantage	$130.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.58
Rate for Payer: Cigna Commercial	$216.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.09
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.05
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$10.45
Rate for Payer: Wellpoint Medicaid Managed Care	$11.49

NM THYROID UPTAKE; SGL

Facility

$433.65

Hospital Charge Code	4500039
Hospital Revenue Code	341
Min. Negotiated Rate	$65.05
Max. Negotiated Rate	$65.05
Rate for Payer: Qualcare PPO/HMO/WC	$65.05

NM TL201 (EA mCi)

Facility

$100.00

Hospital Charge Code	4500666
Hospital Revenue Code	343
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

NM TL201 (EA mCi)

Facility

$100.00

Hospital Charge Code	4500666
Hospital Revenue Code	343
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

NM TUMOR LCLZATN/WHLE BDY 2+DY

Facility

$3,872.85

Service Code	HCPCS 78804
Hospital Charge Code	4501013
Hospital Revenue Code	341
Min. Negotiated Rate	$580.93
Max. Negotiated Rate	$580.93
Rate for Payer: Qualcare PPO/HMO/WC	$580.93

NM TUMOR LCLZATN/WHLE BDY 2+DY

Facility

$3,872.85

Service Code	HCPCS 78804
Hospital Charge Code	4501013
Hospital Revenue Code	341
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$380.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.86
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$580.93
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$93.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$102.63

NM TUMOR LOCALIZATION LIMITED

Facility

$12,000.00

Service Code	HCPCS 78800
Hospital Charge Code	4500690
Hospital Revenue Code	341
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM TUMOR LOCALIZATION LIMITED

Facility

$12,000.00

Service Code	HCPCS 78800
Hospital Charge Code	4500690
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM TUMOR LOCALIZATION MULTIPLE

Facility

$1,776.85

Service Code	HCPCS 78801
Hospital Charge Code	4500682
Hospital Revenue Code	341
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$291.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.05
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.53
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$42.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$47.09

NM TUMOR LOCALIZATION MULTIPLE

Facility

$1,776.85

Service Code	HCPCS 78801
Hospital Charge Code	4500682
Hospital Revenue Code	341
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

NM TUMOR LOCALIZATION (SPECT)

Facility

$12,000.00

Service Code	HCPCS 78803
Hospital Charge Code	4500708
Hospital Revenue Code	341
Min. Negotiated Rate	$184.31
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM TUMOR LOCALIZATION (SPECT)

Facility

$12,000.00

Service Code	HCPCS 78803
Hospital Charge Code	4500708
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM TUMOR LOCALIZ - WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78802
Hospital Charge Code	4500674
Hospital Revenue Code	341
Min. Negotiated Rate	$116.16
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM TUMOR LOCALIZ - WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78802
Hospital Charge Code	4500674
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM TUMOR LOCALIZ WHOLE ZEVALIN

Facility

$2,248.00

Service Code	HCPCS 78802
Hospital Charge Code	4500685
Hospital Revenue Code	341
Min. Negotiated Rate	$337.20
Max. Negotiated Rate	$337.20
Rate for Payer: Qualcare PPO/HMO/WC	$337.20

NM TUMOR LOCALIZ WHOLE ZEVALIN

Facility

$2,248.00

Service Code	HCPCS 78802
Hospital Charge Code	4500685
Hospital Revenue Code	341
Min. Negotiated Rate	$54.18
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$674.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$54.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$59.57

NM TUMOR WHOLE BODY 2+DAYS IMG

Facility

$12,000.00

Service Code	HCPCS 78804
Hospital Charge Code	406078804
Hospital Revenue Code	341
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$380.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

Know your out-of-pocket cost for care.

All Charges