Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE CERV ANT 1LEVEL 10MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270698384
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.12
Max. Negotiated Rate	$4,052.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,684.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12

PLATE CERV ANT 1LEVEL 10MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270698384
Hospital Revenue Code	278
Min. Negotiated Rate	$403.61
Max. Negotiated Rate	$8,373.75
Rate for Payer: Aetna Commercial	$6,364.05
Rate for Payer: Aetna Medicare Advantage	$5,024.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,270.61
Rate for Payer: Cigna Commercial	$8,373.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,684.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12
Rate for Payer: UnitedHealthcare Community & State	$403.61
Rate for Payer: Wellpoint Medicaid Managed Care	$443.81

PLATE CERV ANT 2LEVEL 28MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270698386
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.12
Max. Negotiated Rate	$4,052.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,684.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12

PLATE CERV ANT 2LEVEL 28MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270698386
Hospital Revenue Code	278
Min. Negotiated Rate	$403.61
Max. Negotiated Rate	$8,373.75
Rate for Payer: Aetna Commercial	$6,364.05
Rate for Payer: Aetna Medicare Advantage	$5,024.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,270.61
Rate for Payer: Cigna Commercial	$8,373.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,684.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12
Rate for Payer: UnitedHealthcare Community & State	$403.61
Rate for Payer: Wellpoint Medicaid Managed Care	$443.81

PLATE CERV ANT CYGNUS 2LVL26MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698899
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

PLATE CERV ANT CYGNUS 2LVL26MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698899
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE CERV ANT CYGNUS 8MM 1LEV

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699281
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE CERV ANT CYGNUS 8MM 1LEV

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699281
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

PLATE CERV APTITUDE 1LEV 14MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695376
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE CERV APTITUDE 1LEV 14MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695376
Hospital Revenue Code	278
Min. Negotiated Rate	$463.93
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$463.93
Rate for Payer: Wellpoint Medicaid Managed Care	$510.12

PLATE CERV CERES 3LEVEL 45MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270696503
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,056.00
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

PLATE CERV CERES 3LEVEL 45MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270696503
Hospital Revenue Code	278
Min. Negotiated Rate	$115.68
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,056.00
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$115.68
Rate for Payer: Wellpoint Medicaid Managed Care	$127.20

PLATE CERVICAL 10MM

Facility

$14,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697658
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

PLATE CERVICAL 10MM

Facility

$14,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697658
Hospital Revenue Code	278
Min. Negotiated Rate	$349.45
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$349.45
Rate for Payer: Wellpoint Medicaid Managed Care	$384.25

PLATE CERVICAL 18MM

Facility

$8,250.00

Hospital Charge Code	270676923
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

PLATE CERVICAL 18MM

Facility

$8,250.00

Hospital Charge Code	270676923
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

PLATE CERVICAL 1LEV 10MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693520
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

PLATE CERVICAL 1LEV 10MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

PLATE CERVICAL 1LEV 12MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694850
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

PLATE CERVICAL 1LEV 12MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694850
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

PLATE CERVICAL 1 LEVEL 10MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695159
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

PLATE CERVICAL 1 LEVEL 10MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695159
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

PLATE CERVICAL 1 LEVEL 12MM

Facility

$17,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694889
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

PLATE CERVICAL 1 LEVEL 12MM

Facility

$17,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694889
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

PLATE CERVICAL 1 LEVEL 13MM

Facility

$19,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270696273
Hospital Revenue Code	278
Min. Negotiated Rate	$481.76
Max. Negotiated Rate	$9,995.00
Rate for Payer: Aetna Commercial	$7,596.20
Rate for Payer: Aetna Medicare Advantage	$5,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,097.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,097.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,097.45
Rate for Payer: Cigna Commercial	$9,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,837.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,397.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,998.50
Rate for Payer: UnitedHealthcare Community & State	$481.76
Rate for Payer: Wellpoint Medicaid Managed Care	$529.74

Know your out-of-pocket cost for care.

All Charges