Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE CERV SPACE NANO 18X14X8MM

Facility

$21,097.50

Service Code	HCPCS C1889
Hospital Charge Code	270698383
Hospital Revenue Code	278
Min. Negotiated Rate	$508.45
Max. Negotiated Rate	$10,548.75
Rate for Payer: Aetna Commercial	$8,017.05
Rate for Payer: Aetna Medicare Advantage	$6,329.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,379.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,379.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,219.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,379.86
Rate for Payer: Cigna Commercial	$10,548.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,105.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,641.45
Rate for Payer: Qualcare PPO/HMO/WC	$3,164.62
Rate for Payer: UnitedHealthcare Community & State	$508.45
Rate for Payer: Wellpoint Medicaid Managed Care	$559.08

CAGE CERV SPACER ACIF 18X14X7

Facility

$21,097.50

Service Code	HCPCS C1889
Hospital Charge Code	270698385
Hospital Revenue Code	278
Min. Negotiated Rate	$3,164.62
Max. Negotiated Rate	$5,105.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,219.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,105.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,641.45
Rate for Payer: Qualcare PPO/HMO/WC	$3,164.62

CAGE CERV SPACER ACIF 18X14X7

Facility

$21,097.50

Service Code	HCPCS C1889
Hospital Charge Code	270698385
Hospital Revenue Code	278
Min. Negotiated Rate	$508.45
Max. Negotiated Rate	$10,548.75
Rate for Payer: Aetna Commercial	$8,017.05
Rate for Payer: Aetna Medicare Advantage	$6,329.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,379.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,379.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,219.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,379.86
Rate for Payer: Cigna Commercial	$10,548.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,105.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,641.45
Rate for Payer: Qualcare PPO/HMO/WC	$3,164.62
Rate for Payer: UnitedHealthcare Community & State	$508.45
Rate for Payer: Wellpoint Medicaid Managed Care	$559.08

CAGE CERV W16 MM D14MM

Facility

$12,500.00

Hospital Charge Code	270701860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

CAGE CERV W16 MM D14MM

Facility

$12,500.00

Hospital Charge Code	270701860
Hospital Revenue Code	278
Min. Negotiated Rate	$301.25
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$301.25
Rate for Payer: Wellpoint Medicaid Managed Care	$331.25

CAGE CERV W16MM D14MM FIX SCRW

Facility

$12,500.00

Hospital Charge Code	270701881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

CAGE CERV W16MM D14MM FIX SCRW

Facility

$12,500.00

Hospital Charge Code	270701881
Hospital Revenue Code	278
Min. Negotiated Rate	$301.25
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$301.25
Rate for Payer: Wellpoint Medicaid Managed Care	$331.25

CAGE CIF EIT 6MM 4D L

Facility

$8,134.50

Service Code	HCPCS C1889
Hospital Charge Code	270698987
Hospital Revenue Code	278
Min. Negotiated Rate	$1,220.17
Max. Negotiated Rate	$1,968.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,968.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,789.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.17

CAGE CIF EIT 6MM 4D L

Facility

$8,134.50

Service Code	HCPCS C1889
Hospital Charge Code	270698987
Hospital Revenue Code	278
Min. Negotiated Rate	$196.04
Max. Negotiated Rate	$4,067.25
Rate for Payer: Aetna Commercial	$3,091.11
Rate for Payer: Aetna Medicare Advantage	$2,440.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,074.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,074.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,074.30
Rate for Payer: Cigna Commercial	$4,067.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,968.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,789.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.17
Rate for Payer: UnitedHealthcare Community & State	$196.04
Rate for Payer: Wellpoint Medicaid Managed Care	$215.56

CAGE COALESCE 8X10X28MM 2DEG

Facility

$24,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270694899
Hospital Revenue Code	278
Min. Negotiated Rate	$583.22
Max. Negotiated Rate	$12,100.00
Rate for Payer: Aetna Commercial	$9,196.00
Rate for Payer: Aetna Medicare Advantage	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,171.00
Rate for Payer: Cigna Commercial	$12,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00
Rate for Payer: UnitedHealthcare Community & State	$583.22
Rate for Payer: Wellpoint Medicaid Managed Care	$641.30

CAGE COALESCE 8X10X28MM 2DEG

Facility

$24,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270694899
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$5,856.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

CAGE COALESCE LORDOT 10X28X8MM

Facility

$24,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270691781
Hospital Revenue Code	278
Min. Negotiated Rate	$583.22
Max. Negotiated Rate	$12,100.00
Rate for Payer: Aetna Commercial	$9,196.00
Rate for Payer: Aetna Medicare Advantage	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,171.00
Rate for Payer: Cigna Commercial	$12,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00
Rate for Payer: UnitedHealthcare Community & State	$583.22
Rate for Payer: Wellpoint Medicaid Managed Care	$641.30

CAGE COALESCE LORDOT 10X28X8MM

Facility

$24,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270691781
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$5,856.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

CAGE COALESCE STR 9X10X28MM 8D

Facility

$24,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270694732
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$5,856.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

CAGE COALESCE STR 9X10X28MM 8D

Facility

$24,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270694732
Hospital Revenue Code	278
Min. Negotiated Rate	$583.22
Max. Negotiated Rate	$12,100.00
Rate for Payer: Aetna Commercial	$9,196.00
Rate for Payer: Aetna Medicare Advantage	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,171.00
Rate for Payer: Cigna Commercial	$12,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00
Rate for Payer: UnitedHealthcare Community & State	$583.22
Rate for Payer: Wellpoint Medicaid Managed Care	$641.30

CAGE COALES STR 11X10X28MM 8D

Facility

$24,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270694845
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$5,856.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

CAGE COALES STR 11X10X28MM 8D

Facility

$24,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270694845
Hospital Revenue Code	278
Min. Negotiated Rate	$583.22
Max. Negotiated Rate	$12,100.00
Rate for Payer: Aetna Commercial	$9,196.00
Rate for Payer: Aetna Medicare Advantage	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,171.00
Rate for Payer: Cigna Commercial	$12,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00
Rate for Payer: UnitedHealthcare Community & State	$583.22
Rate for Payer: Wellpoint Medicaid Managed Care	$641.30

CAGE COHERE 7D 14X16X7MM

Facility

$9,075.00

Service Code	HCPCS C1889
Hospital Charge Code	270696633
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

CAGE COHERE 7D 14X16X7MM

Facility

$9,075.00

Service Code	HCPCS C1889
Hospital Charge Code	270696633
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

CAGE COHERE CERV 10X14X12MM 7D

Facility

$9,075.00

Service Code	HCPCS C1889
Hospital Charge Code	270695127
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

CAGE COHERE CERV 10X14X12MM 7D

Facility

$9,075.00

Service Code	HCPCS C1889
Hospital Charge Code	270695127
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

CAGE COHERE CERV 9X14X12MM 7D

Facility

$9,075.00

Service Code	HCPCS C1889
Hospital Charge Code	270694181
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

CAGE COHERE CERV 9X14X12MM 7D

Facility

$9,075.00

Service Code	HCPCS C1889
Hospital Charge Code	270694181
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

CAGE COHERE CERVICAL 12X14X7MM

Facility

$9,075.00

Service Code	HCPCS C1889
Hospital Charge Code	270693349
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

CAGE COHERE CERVICAL 12X14X7MM

Facility

$9,075.00

Service Code	HCPCS C1889
Hospital Charge Code	270693349
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

Know your out-of-pocket cost for care.

All Charges