Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE VA-LCP 2.4MM 6H/2H RT ST

Facility

$4,288.90

Service Code	HCPCS C1713
Hospital Charge Code	270677144
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 2.4MM 6H/3H LEFT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270661958
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 2.4MM 6H/3H LEFT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270661958
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 2.4MM 6H/3H LT ST

Facility

$4,449.60

Service Code	HCPCS C1713
Hospital Charge Code	270663936
Hospital Revenue Code	278
Min. Negotiated Rate	$667.44
Max. Negotiated Rate	$1,076.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$978.91
Rate for Payer: Qualcare PPO/HMO/WC	$667.44

PLATE VA-LCP 2.4MM 6H/3H LT ST

Facility

$4,449.60

Service Code	HCPCS C1713
Hospital Charge Code	270663936
Hospital Revenue Code	278
Min. Negotiated Rate	$107.24
Max. Negotiated Rate	$2,224.80
Rate for Payer: Aetna Commercial	$1,690.85
Rate for Payer: Aetna Medicare Advantage	$1,334.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.65
Rate for Payer: Cigna Commercial	$2,224.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$978.91
Rate for Payer: Qualcare PPO/HMO/WC	$667.44
Rate for Payer: UnitedHealthcare Community & State	$107.24
Rate for Payer: Wellpoint Medicaid Managed Care	$117.91

PLATE VA-LCP 2.4MM 6H/3H RIGHT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270676425
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 2.4MM 6H/3H RIGHT

Facility

$4,583.10

Service Code	HCPCS C1713
Hospital Charge Code	270680600
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 2.4MM 6H/3H RIGHT

Facility

$4,583.10

Service Code	HCPCS C1713
Hospital Charge Code	270680600
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 2.4MM 6H/3H RIGHT

Facility

$4,242.55

Service Code	HCPCS C1713
Hospital Charge Code	270676425
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 2.4MM 6H/4H LEFT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270676426
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 2.4MM 6H/4H LEFT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270676426
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 2.4MM 6H/4H RIGHT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270676427
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 2.4MM 6H/4H RIGHT

Facility

$4,403.25

Service Code	HCPCS C1713
Hospital Charge Code	270676427
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 2.4MM 6H/4H RT ST

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270670539
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 2.4MM 6H/4H RT ST

Facility

$4,610.30

Service Code	HCPCS C1713
Hospital Charge Code	270670539
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 2.4MM 6H/5H LEFT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676429
Hospital Revenue Code	278
Min. Negotiated Rate	$110.06
Max. Negotiated Rate	$2,283.50
Rate for Payer: Aetna Commercial	$1,735.46
Rate for Payer: Aetna Medicare Advantage	$1,370.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.59
Rate for Payer: Cigna Commercial	$2,283.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,105.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.74
Rate for Payer: Qualcare PPO/HMO/WC	$685.05
Rate for Payer: UnitedHealthcare Community & State	$110.06
Rate for Payer: Wellpoint Medicaid Managed Care	$121.03

PLATE VA-LCP 2.4MM 6H/5H LEFT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676429
Hospital Revenue Code	278
Min. Negotiated Rate	$685.05
Max. Negotiated Rate	$1,105.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,105.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.74
Rate for Payer: Qualcare PPO/HMO/WC	$685.05

PLATE VA-LCP 2.4MM 6H/5H RIGHT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676428
Hospital Revenue Code	278
Min. Negotiated Rate	$110.06
Max. Negotiated Rate	$2,283.50
Rate for Payer: Aetna Commercial	$1,735.46
Rate for Payer: Aetna Medicare Advantage	$1,370.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.59
Rate for Payer: Cigna Commercial	$2,283.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,105.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.74
Rate for Payer: Qualcare PPO/HMO/WC	$685.05
Rate for Payer: UnitedHealthcare Community & State	$110.06
Rate for Payer: Wellpoint Medicaid Managed Care	$121.03

PLATE VA-LCP 2.4MM 6H/5H RIGHT

Facility

$4,567.00

Service Code	HCPCS C1713
Hospital Charge Code	270676428
Hospital Revenue Code	278
Min. Negotiated Rate	$685.05
Max. Negotiated Rate	$1,105.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,105.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.74
Rate for Payer: Qualcare PPO/HMO/WC	$685.05

PLATE VA-LCP 2.7/3.5 2H/L/73MM

Facility

$3,918.10

Hospital Charge Code	270677622
Hospital Revenue Code	278
Min. Negotiated Rate	$94.43
Max. Negotiated Rate	$1,959.05
Rate for Payer: Aetna Commercial	$1,488.88
Rate for Payer: Aetna Medicare Advantage	$1,175.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$999.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$999.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$999.12
Rate for Payer: Cigna Commercial	$1,959.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$948.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$861.98
Rate for Payer: Qualcare PPO/HMO/WC	$587.72
Rate for Payer: UnitedHealthcare Community & State	$94.43
Rate for Payer: Wellpoint Medicaid Managed Care	$103.83

PLATE VA-LCP 2.7/3.5 2H/L/73MM

Facility

$3,918.10

Hospital Charge Code	270677622
Hospital Revenue Code	278
Min. Negotiated Rate	$587.72
Max. Negotiated Rate	$948.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$948.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$861.98
Rate for Payer: Qualcare PPO/HMO/WC	$587.72

PLATE VA-LCP 2.7/3.5 2H L 90MM

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270670537
Hospital Revenue Code	278
Min. Negotiated Rate	$111.18
Max. Negotiated Rate	$2,306.68
Rate for Payer: Aetna Commercial	$1,753.07
Rate for Payer: Aetna Medicare Advantage	$1,384.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$2,306.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00
Rate for Payer: UnitedHealthcare Community & State	$111.18
Rate for Payer: Wellpoint Medicaid Managed Care	$122.25

PLATE VA-LCP 2.7/3.5 2H L 90MM

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270670537
Hospital Revenue Code	278
Min. Negotiated Rate	$692.00
Max. Negotiated Rate	$1,116.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00

PLATE VA-LCP 2.7/3.5 2H LT

Facility

$4,406.35

Service Code	HCPCS C1713
Hospital Charge Code	270674356
Hospital Revenue Code	278
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$2,203.18
Rate for Payer: Aetna Commercial	$1,674.41
Rate for Payer: Aetna Medicare Advantage	$1,321.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.62
Rate for Payer: Cigna Commercial	$2,203.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95
Rate for Payer: UnitedHealthcare Community & State	$106.19
Rate for Payer: Wellpoint Medicaid Managed Care	$116.77

PLATE VA-LCP 2.7/3.5 2H LT

Facility

$4,406.35

Service Code	HCPCS C1713
Hospital Charge Code	270674356
Hospital Revenue Code	278
Min. Negotiated Rate	$660.95
Max. Negotiated Rate	$1,066.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95

Know your out-of-pocket cost for care.

All Charges