Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH CHLORIDE URINE 24 HR

Facility

$57.00

Service Code	HCPCS 82436
Hospital Charge Code	397071291
Hospital Revenue Code	301
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$114.00
Rate for Payer: Wellcare Medicare Advantage	$5.75
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.07
Rate for Payer: Cigna Commercial	$5.75
Rate for Payer: Cigna Medicare Advantage	$2.88
Rate for Payer: Clover Medicare Advantage	$5.46
Rate for Payer: EmblemHealth Commercial	$17.25
Rate for Payer: Humana Medicare Advantage	$5.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.09

CH CHLORIDE URINE 24 HR

Facility

$57.00

Service Code	HCPCS 82436
Hospital Charge Code	397071291
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

CH CHLORPROMAZINES

Facility

$225.00

Service Code	HCPCS 80299
Hospital Charge Code	397073064
Hospital Revenue Code	301
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CH CHLORPROMAZINES

Facility

$225.00

Service Code	HCPCS 80299
Hospital Charge Code	397073064
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

CH CHOLESTEROL

Facility

$92.00

Service Code	HCPCS 82465
Hospital Charge Code	397071146
Hospital Revenue Code	301
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$4.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$4.35
Rate for Payer: Cigna Medicare Advantage	$2.17
Rate for Payer: Clover Medicare Advantage	$4.13
Rate for Payer: EmblemHealth Commercial	$13.05
Rate for Payer: Humana Medicare Advantage	$4.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.61
Rate for Payer: Wellcare Medicare Advantage	$4.35

CH CHOLESTEROL

Facility

$92.00

Service Code	HCPCS 82465
Hospital Charge Code	397071146
Hospital Revenue Code	301
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

CH CHOLESTEROL FLUID

Facility

$52.85

Service Code	HCPCS 82465
Hospital Charge Code	397073045
Hospital Revenue Code	301
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$4.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$4.35
Rate for Payer: Cigna Medicare Advantage	$2.17
Rate for Payer: Clover Medicare Advantage	$4.13
Rate for Payer: EmblemHealth Commercial	$13.05
Rate for Payer: Humana Medicare Advantage	$4.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.93
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.61
Rate for Payer: Wellcare Medicare Advantage	$4.35

CH CHOLESTEROL FLUID

Facility

$52.85

Service Code	HCPCS 82465
Hospital Charge Code	397073045
Hospital Revenue Code	301
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.93

CH CHOLINESTERASE PLASMA

Facility

$159.00

Service Code	HCPCS 82480
Hospital Charge Code	397071052
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.50
Rate for Payer: Aetna Medicare Advantage	$7.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.84
Rate for Payer: Cigna Commercial	$7.87
Rate for Payer: Cigna Medicare Advantage	$3.94
Rate for Payer: Clover Medicare Advantage	$7.48
Rate for Payer: EmblemHealth Commercial	$23.61
Rate for Payer: Humana Medicare Advantage	$8.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.34
Rate for Payer: Wellcare Medicare Advantage	$7.87

CH CHOLINESTERASE PLASMA

Facility

$159.00

Service Code	HCPCS 82480
Hospital Charge Code	397071052
Hospital Revenue Code	301
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

CH CHOLINESTERASE RBC

Facility

$195.00

Service Code	HCPCS 82482
Hospital Charge Code	397072045
Hospital Revenue Code	301
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CH CHOLINESTERASE RBC

Facility

$195.00

Service Code	HCPCS 82482
Hospital Charge Code	397072045
Hospital Revenue Code	301
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.78
Rate for Payer: Aetna Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.94
Rate for Payer: Cigna Commercial	$9.81
Rate for Payer: Cigna Medicare Advantage	$4.91
Rate for Payer: Clover Medicare Advantage	$9.32
Rate for Payer: EmblemHealth Commercial	$29.43
Rate for Payer: Humana Medicare Advantage	$10.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.40
Rate for Payer: Wellcare Medicare Advantage	$9.81

CH CHROMATOGRAPHY

Facility

$111.00

Service Code	HCPCS 83021
Hospital Charge Code	397073651
Hospital Revenue Code	301
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.51
Rate for Payer: Aetna Medicare Advantage	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.17
Rate for Payer: Cigna Commercial	$18.06
Rate for Payer: Cigna Medicare Advantage	$9.03
Rate for Payer: Clover Medicare Advantage	$17.16
Rate for Payer: EmblemHealth Commercial	$54.18
Rate for Payer: Humana Medicare Advantage	$18.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.06
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.14
Rate for Payer: Wellcare Medicare Advantage	$18.06

CH CHROMATOGRAPHY

Facility

$111.00

Service Code	HCPCS 83021
Hospital Charge Code	397073651
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

CH CHROMIUM SERUM

Facility

$174.00

Service Code	HCPCS 82495
Hospital Charge Code	397072046
Hospital Revenue Code	301
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

CH CHROMIUM SERUM

Facility

$174.00

Service Code	HCPCS 82495
Hospital Charge Code	397072046
Hospital Revenue Code	301
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.71
Rate for Payer: Aetna Medicare Advantage	$20.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.31
Rate for Payer: Cigna Commercial	$20.28
Rate for Payer: Cigna Medicare Advantage	$10.14
Rate for Payer: Clover Medicare Advantage	$19.27
Rate for Payer: EmblemHealth Commercial	$60.84
Rate for Payer: Humana Medicare Advantage	$20.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.50
Rate for Payer: Wellcare Medicare Advantage	$20.28

CH CHROMIUM, URINE

Facility

$759.00

Service Code	HCPCS 82495
Hospital Charge Code	397073088
Hospital Revenue Code	301
Min. Negotiated Rate	$113.85
Max. Negotiated Rate	$113.85
Rate for Payer: Qualcare PPO/HMO/WC	$113.85

CH CHROMIUM, URINE

Facility

$759.00

Service Code	HCPCS 82495
Hospital Charge Code	397073088
Hospital Revenue Code	301
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.71
Rate for Payer: Aetna Medicare Advantage	$20.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.31
Rate for Payer: Cigna Commercial	$20.28
Rate for Payer: Cigna Medicare Advantage	$10.14
Rate for Payer: Clover Medicare Advantage	$19.27
Rate for Payer: EmblemHealth Commercial	$60.84
Rate for Payer: Humana Medicare Advantage	$20.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.50
Rate for Payer: Wellcare Medicare Advantage	$20.28

CH CHROMOGRANIN A

Facility

$277.00

Service Code	HCPCS 83519
Hospital Charge Code	397073568
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.62
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.42
Rate for Payer: Cigna Commercial	$18.40
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.50
Rate for Payer: Wellcare Medicare Advantage	$18.40

CH CHROMOGRANIN A

Facility

$277.00

Service Code	HCPCS 83519
Hospital Charge Code	397073568
Hospital Revenue Code	301
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.55

CH CHROMOSOME AMNIOTIC FLUID

Facility

$1,800.00

Service Code	HCPCS 88267
Hospital Charge Code	397071334
Hospital Revenue Code	311
Min. Negotiated Rate	$94.28
Max. Negotiated Rate	$690.92
Rate for Payer: Aetna Commercial	$610.97
Rate for Payer: Aetna Medicare Advantage	$188.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$690.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$690.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$188.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$690.92
Rate for Payer: Cigna Commercial	$188.57
Rate for Payer: Cigna Medicare Advantage	$94.28
Rate for Payer: Clover Medicare Advantage	$179.14
Rate for Payer: EmblemHealth Commercial	$565.71
Rate for Payer: Humana Medicare Advantage	$194.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$188.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$199.88
Rate for Payer: Wellcare Medicare Advantage	$188.57

CH CHROMOSOME AMNIOTIC FLUID

Facility

$1,800.00

Service Code	HCPCS 88267
Hospital Charge Code	397071334
Hospital Revenue Code	311
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

CH CHROMOSOME ANAL PHILADEL

Facility

$2,714.00

Service Code	HCPCS 88237
Hospital Charge Code	397071332
Hospital Revenue Code	311
Min. Negotiated Rate	$71.88
Max. Negotiated Rate	$526.70
Rate for Payer: Aetna Commercial	$465.75
Rate for Payer: Aetna Medicare Advantage	$143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.70
Rate for Payer: Cigna Commercial	$143.75
Rate for Payer: Cigna Medicare Advantage	$71.88
Rate for Payer: Clover Medicare Advantage	$136.56
Rate for Payer: EmblemHealth Commercial	$431.25
Rate for Payer: Humana Medicare Advantage	$148.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$407.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$152.38
Rate for Payer: Wellcare Medicare Advantage	$143.75

CH CHROMOSOME ANAL PHILADEL

Facility

$2,714.00

Service Code	HCPCS 88237
Hospital Charge Code	397071332
Hospital Revenue Code	311
Min. Negotiated Rate	$407.10
Max. Negotiated Rate	$407.10
Rate for Payer: Qualcare PPO/HMO/WC	$407.10

CH CHROMOSOME ANALYSIS

Facility

$796.00

Service Code	HCPCS 88281
Hospital Charge Code	397073331
Hospital Revenue Code	311
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$398.00
Rate for Payer: Aetna Commercial	$238.80
Rate for Payer: Aetna Medicare Advantage	$238.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.98
Rate for Payer: Cigna Commercial	$398.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.40
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges