Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE VA-LCP 2.4/2.7MM 2 HOLE

Facility

$4,822.60

Service Code	HCPCS C1713
Hospital Charge Code	270695925
Hospital Revenue Code	278
Min. Negotiated Rate	$116.22
Max. Negotiated Rate	$2,411.30
Rate for Payer: Aetna Commercial	$1,832.59
Rate for Payer: Aetna Medicare Advantage	$1,446.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,229.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$964.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,229.76
Rate for Payer: Cigna Commercial	$2,411.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,167.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,060.97
Rate for Payer: Qualcare PPO/HMO/WC	$723.39
Rate for Payer: UnitedHealthcare Community & State	$116.22
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

PLATE VALCP 2.4 2CL HD 7H/3H R

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270679374
Hospital Revenue Code	278
Min. Negotiated Rate	$102.25
Max. Negotiated Rate	$2,121.28
Rate for Payer: Aetna Commercial	$1,612.17
Rate for Payer: Aetna Medicare Advantage	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,081.85
Rate for Payer: Cigna Commercial	$2,121.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$933.36
Rate for Payer: Qualcare PPO/HMO/WC	$636.38
Rate for Payer: UnitedHealthcare Community & State	$102.25
Rate for Payer: Wellpoint Medicaid Managed Care	$112.43

PLATE VALCP 2.4 2CL HD 7H/3H R

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270679374
Hospital Revenue Code	278
Min. Negotiated Rate	$636.38
Max. Negotiated Rate	$1,026.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$933.36
Rate for Payer: Qualcare PPO/HMO/WC	$636.38

PLATE VA-LCP 2.4 2 CLM 6H/3H R

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270661960
Hospital Revenue Code	278
Min. Negotiated Rate	$102.25
Max. Negotiated Rate	$2,121.28
Rate for Payer: Aetna Commercial	$1,612.17
Rate for Payer: Aetna Medicare Advantage	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,081.85
Rate for Payer: Cigna Commercial	$2,121.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$933.36
Rate for Payer: Qualcare PPO/HMO/WC	$636.38
Rate for Payer: UnitedHealthcare Community & State	$102.25
Rate for Payer: Wellpoint Medicaid Managed Care	$112.43

PLATE VA-LCP 2.4 2 CLM 6H/3H R

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270661960
Hospital Revenue Code	278
Min. Negotiated Rate	$636.38
Max. Negotiated Rate	$1,026.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$933.36
Rate for Payer: Qualcare PPO/HMO/WC	$636.38

PLATE VA-LCP 2.4 2COL 6H/2H LT

Facility

$4,288.90

Hospital Charge Code	270677782
Hospital Revenue Code	278
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$2,144.45
Rate for Payer: Aetna Commercial	$1,629.78
Rate for Payer: Aetna Medicare Advantage	$1,286.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.67
Rate for Payer: Cigna Commercial	$2,144.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$943.56
Rate for Payer: Qualcare PPO/HMO/WC	$643.34
Rate for Payer: UnitedHealthcare Community & State	$103.36
Rate for Payer: Wellpoint Medicaid Managed Care	$113.66

PLATE VA-LCP 2.4 2COL 6H/2H LT

Facility

$4,288.90

Hospital Charge Code	270677782
Hospital Revenue Code	278
Min. Negotiated Rate	$643.34
Max. Negotiated Rate	$1,037.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$943.56
Rate for Payer: Qualcare PPO/HMO/WC	$643.34

PLATE VA-LCP 2.4 2COL 6H/2H RT

Facility

$4,081.90

Service Code	HCPCS C1713
Hospital Charge Code	270679203
Hospital Revenue Code	278
Min. Negotiated Rate	$98.37
Max. Negotiated Rate	$2,040.95
Rate for Payer: Aetna Commercial	$1,551.12
Rate for Payer: Aetna Medicare Advantage	$1,224.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,040.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,040.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,040.88
Rate for Payer: Cigna Commercial	$2,040.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$898.02
Rate for Payer: Qualcare PPO/HMO/WC	$612.28
Rate for Payer: UnitedHealthcare Community & State	$98.37
Rate for Payer: Wellpoint Medicaid Managed Care	$108.17

PLATE VA-LCP 2.4 2COL 6H/2H RT

Facility

$4,417.55

Service Code	HCPCS C1713
Hospital Charge Code	270661259
Hospital Revenue Code	278
Min. Negotiated Rate	$662.63
Max. Negotiated Rate	$1,069.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$883.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,069.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$971.86
Rate for Payer: Qualcare PPO/HMO/WC	$662.63

PLATE VA-LCP 2.4 2COL 6H/2H RT

Facility

$4,081.90

Service Code	HCPCS C1713
Hospital Charge Code	270679203
Hospital Revenue Code	278
Min. Negotiated Rate	$612.28
Max. Negotiated Rate	$987.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$898.02
Rate for Payer: Qualcare PPO/HMO/WC	$612.28

PLATE VA-LCP 2.4 2COL 6H/2H RT

Facility

$4,417.55

Service Code	HCPCS C1713
Hospital Charge Code	270661259
Hospital Revenue Code	278
Min. Negotiated Rate	$106.46
Max. Negotiated Rate	$2,208.78
Rate for Payer: Aetna Commercial	$1,678.67
Rate for Payer: Aetna Medicare Advantage	$1,325.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,126.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,126.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$883.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,126.48
Rate for Payer: Cigna Commercial	$2,208.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,069.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$971.86
Rate for Payer: Qualcare PPO/HMO/WC	$662.63
Rate for Payer: UnitedHealthcare Community & State	$106.46
Rate for Payer: Wellpoint Medicaid Managed Care	$117.07

PLATE VA-LCP 2.4 2COL 6H/3H LT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270645535
Hospital Revenue Code	278
Min. Negotiated Rate	$102.25
Max. Negotiated Rate	$2,121.28
Rate for Payer: Aetna Commercial	$1,612.17
Rate for Payer: Aetna Medicare Advantage	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,081.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,081.85
Rate for Payer: Cigna Commercial	$2,121.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$933.36
Rate for Payer: Qualcare PPO/HMO/WC	$636.38
Rate for Payer: UnitedHealthcare Community & State	$102.25
Rate for Payer: Wellpoint Medicaid Managed Care	$112.43

PLATE VA-LCP 2.4 2COL 6H/3H LT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270645535
Hospital Revenue Code	278
Min. Negotiated Rate	$636.38
Max. Negotiated Rate	$1,026.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$933.36
Rate for Payer: Qualcare PPO/HMO/WC	$636.38

PLATE VA-LCP 2.4 2COL 6H/3H LT

Facility

$4,583.10

Service Code	HCPCS C1713
Hospital Charge Code	270645636
Hospital Revenue Code	278
Min. Negotiated Rate	$110.45
Max. Negotiated Rate	$2,291.55
Rate for Payer: Aetna Commercial	$1,741.58
Rate for Payer: Aetna Medicare Advantage	$1,374.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,168.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,168.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,168.69
Rate for Payer: Cigna Commercial	$2,291.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,008.28
Rate for Payer: Qualcare PPO/HMO/WC	$687.47
Rate for Payer: UnitedHealthcare Community & State	$110.45
Rate for Payer: Wellpoint Medicaid Managed Care	$121.45

PLATE VA-LCP 2.4 2COL 6H/3H LT

Facility

$4,583.10

Service Code	HCPCS C1713
Hospital Charge Code	270645636
Hospital Revenue Code	278
Min. Negotiated Rate	$687.47
Max. Negotiated Rate	$1,109.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,008.28
Rate for Payer: Qualcare PPO/HMO/WC	$687.47

PLATE VA-LCP 2.4 2COL 6H/3H RT

Facility

$4,583.10

Service Code	HCPCS C1713
Hospital Charge Code	270646342
Hospital Revenue Code	278
Min. Negotiated Rate	$110.45
Max. Negotiated Rate	$2,291.55
Rate for Payer: Aetna Commercial	$1,741.58
Rate for Payer: Aetna Medicare Advantage	$1,374.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,168.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,168.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,168.69
Rate for Payer: Cigna Commercial	$2,291.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,008.28
Rate for Payer: Qualcare PPO/HMO/WC	$687.47
Rate for Payer: UnitedHealthcare Community & State	$110.45
Rate for Payer: Wellpoint Medicaid Managed Care	$121.45

PLATE VA-LCP 2.4 2COL 6H/3H RT

Facility

$4,583.10

Service Code	HCPCS C1713
Hospital Charge Code	270646342
Hospital Revenue Code	278
Min. Negotiated Rate	$687.47
Max. Negotiated Rate	$1,109.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,008.28
Rate for Payer: Qualcare PPO/HMO/WC	$687.47

PLATE VA-LCP 2.4 2COL 6H/4H LT

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270674937
Hospital Revenue Code	278
Min. Negotiated Rate	$691.54
Max. Negotiated Rate	$1,115.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.27
Rate for Payer: Qualcare PPO/HMO/WC	$691.54

PLATE VA-LCP 2.4 2COL 6H/4H LT

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270674937
Hospital Revenue Code	278
Min. Negotiated Rate	$111.11
Max. Negotiated Rate	$2,305.15
Rate for Payer: Aetna Commercial	$1,751.91
Rate for Payer: Aetna Medicare Advantage	$1,383.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,175.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,175.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,175.63
Rate for Payer: Cigna Commercial	$2,305.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.27
Rate for Payer: Qualcare PPO/HMO/WC	$691.54
Rate for Payer: UnitedHealthcare Community & State	$111.11
Rate for Payer: Wellpoint Medicaid Managed Care	$122.17

PLATE VA-LCP 2.4 2COL 6H/4H LT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270675320
Hospital Revenue Code	278
Min. Negotiated Rate	$106.12
Max. Negotiated Rate	$2,201.62
Rate for Payer: Aetna Commercial	$1,673.23
Rate for Payer: Aetna Medicare Advantage	$1,320.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.83
Rate for Payer: Cigna Commercial	$2,201.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$968.72
Rate for Payer: Qualcare PPO/HMO/WC	$660.49
Rate for Payer: UnitedHealthcare Community & State	$106.12
Rate for Payer: Wellpoint Medicaid Managed Care	$116.69

PLATE VA-LCP 2.4 2COL 6H/4H LT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270675320
Hospital Revenue Code	278
Min. Negotiated Rate	$660.49
Max. Negotiated Rate	$1,065.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$968.72
Rate for Payer: Qualcare PPO/HMO/WC	$660.49

PLATE VA-LCP 2.4 2COL 6H/4H RT

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270661257
Hospital Revenue Code	278
Min. Negotiated Rate	$111.11
Max. Negotiated Rate	$2,305.15
Rate for Payer: Aetna Commercial	$1,751.91
Rate for Payer: Aetna Medicare Advantage	$1,383.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,175.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,175.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,175.63
Rate for Payer: Cigna Commercial	$2,305.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.27
Rate for Payer: Qualcare PPO/HMO/WC	$691.54
Rate for Payer: UnitedHealthcare Community & State	$111.11
Rate for Payer: Wellpoint Medicaid Managed Care	$122.17

PLATE VA-LCP 2.4 2COL 6H/4H RT

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270661257
Hospital Revenue Code	278
Min. Negotiated Rate	$691.54
Max. Negotiated Rate	$1,115.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.27
Rate for Payer: Qualcare PPO/HMO/WC	$691.54

PLATE VA-LCP 2.4 2COL 6H HD/3H

Facility

$4,369.85

Service Code	HCPCS C1713
Hospital Charge Code	270680391
Hospital Revenue Code	278
Min. Negotiated Rate	$105.31
Max. Negotiated Rate	$2,184.93
Rate for Payer: Aetna Commercial	$1,660.54
Rate for Payer: Aetna Medicare Advantage	$1,310.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,114.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,114.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$873.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,114.31
Rate for Payer: Cigna Commercial	$2,184.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,057.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$961.37
Rate for Payer: Qualcare PPO/HMO/WC	$655.48
Rate for Payer: UnitedHealthcare Community & State	$105.31
Rate for Payer: Wellpoint Medicaid Managed Care	$115.80

PLATE VA-LCP 2.4 2COL 6H HD/3H

Facility

$4,369.85

Service Code	HCPCS C1713
Hospital Charge Code	270680391
Hospital Revenue Code	278
Min. Negotiated Rate	$655.48
Max. Negotiated Rate	$1,057.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$873.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,057.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$961.37
Rate for Payer: Qualcare PPO/HMO/WC	$655.48

Know your out-of-pocket cost for care.

All Charges