Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LUMB SYMP PARAVERT INJ (ANES)

Facility

$3,103.00

Service Code	HCPCS 64520
Hospital Charge Code	84506045
Hospital Revenue Code	361
Min. Negotiated Rate	$465.45
Max. Negotiated Rate	$465.45
Rate for Payer: Qualcare PPO/HMO/WC	$465.45

LUNA GRAFT INJECTOR

Facility

$5,104.00

Hospital Charge Code	270697375
Hospital Revenue Code	272
Min. Negotiated Rate	$765.60
Max. Negotiated Rate	$765.60
Rate for Payer: Qualcare PPO/HMO/WC	$765.60

LUNA GRAFT INJECTOR

Facility

$5,104.00

Hospital Charge Code	270697375
Hospital Revenue Code	272
Min. Negotiated Rate	$144.95
Max. Negotiated Rate	$2,552.00
Rate for Payer: Aetna Commercial	$1,939.52
Rate for Payer: Aetna Medicare Advantage	$1,531.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,301.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,301.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,301.52
Rate for Payer: Cigna Commercial	$2,552.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,327.04
Rate for Payer: Oxford Commercial	$1,020.80
Rate for Payer: Qualcare PPO/HMO/WC	$765.60
Rate for Payer: UnitedHealthcare Commercial	$1,020.80
Rate for Payer: UnitedHealthcare Community & State	$161.29
Rate for Payer: Wellpoint Medicaid Managed Care	$144.95

LUNA XD IMPLANT 12D 12MM

Facility

$53,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270697374
Hospital Revenue Code	278
Min. Negotiated Rate	$1,522.24
Max. Negotiated Rate	$26,800.00
Rate for Payer: Aetna Commercial	$20,368.00
Rate for Payer: Aetna Medicare Advantage	$16,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,668.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,668.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,668.00
Rate for Payer: Cigna Commercial	$26,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,971.20
Rate for Payer: Qualcare PPO/HMO/WC	$8,040.00
Rate for Payer: UnitedHealthcare Community & State	$1,693.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1,522.24

LUNA XD IMPLANT 12D 12MM

Facility

$53,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270697374
Hospital Revenue Code	278
Min. Negotiated Rate	$8,040.00
Max. Negotiated Rate	$12,971.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,971.20
Rate for Payer: Qualcare PPO/HMO/WC	$8,040.00

LUNDERQIST EXTRA STIFF WIRE

Facility

$1,506.25

Hospital Charge Code	270658322
Hospital Revenue Code	272
Min. Negotiated Rate	$225.94
Max. Negotiated Rate	$225.94
Rate for Payer: Qualcare PPO/HMO/WC	$225.94

LUNDERQIST EXTRA STIFF WIRE

Facility

$1,506.25

Hospital Charge Code	270658322
Hospital Revenue Code	272
Min. Negotiated Rate	$42.78
Max. Negotiated Rate	$753.12
Rate for Payer: Aetna Commercial	$572.38
Rate for Payer: Aetna Medicare Advantage	$451.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$384.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$384.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$384.09
Rate for Payer: Cigna Commercial	$753.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.62
Rate for Payer: Oxford Commercial	$301.25
Rate for Payer: Qualcare PPO/HMO/WC	$225.94
Rate for Payer: UnitedHealthcare Commercial	$301.25
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$42.78

LUNG PERF & VENT SCAN

Facility

$12,000.00

Service Code	HCPCS 78582
Hospital Charge Code	4500928
Hospital Revenue Code	341
Min. Negotiated Rate	$236.63
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$236.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,120.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

LUNG PERF & VENT SCAN

Facility

$12,000.00

Service Code	HCPCS 78582
Hospital Charge Code	4500928
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

LUNG TRANSPLANT

Facility

$428,607.54

Service Code	MSDRG 007
Min. Negotiated Rate	$130,505.50
Max. Negotiated Rate	$428,607.54
Rate for Payer: Aetna Medicare Advantage	$428,607.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$339,940.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$339,940.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$137,374.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$339,940.35
Rate for Payer: Cigna Commercial	$288,698.81
Rate for Payer: Cigna Medicare Advantage	$137,374.21
Rate for Payer: Clover Medicare Advantage	$130,505.50
Rate for Payer: EmblemHealth Commercial	$412,122.63
Rate for Payer: Humana Medicare Advantage	$141,495.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$137,374.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$137,374.21
Rate for Payer: Wellcare Medicare Advantage	$137,374.21

LUPUS ANTICOAG,HEXAGONAL

Facility

$667.59

Service Code	HCPCS 85598
Hospital Charge Code	39900179
Hospital Revenue Code	305
Min. Negotiated Rate	$14.38
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.22
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

LUPUS ANTICOAG,HEXAGONAL

Facility

$667.59

Service Code	HCPCS 85598
Hospital Charge Code	39900179
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LUPUS ANTICOAGULANT

Facility

$107.00

Service Code	HCPCS 85613
Hospital Charge Code	38478074
Hospital Revenue Code	305
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$26.06
Rate for Payer: Aetna Medicare Advantage	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.75
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: Cigna Medicare Advantage	$9.58
Rate for Payer: Clover Medicare Advantage	$9.10
Rate for Payer: EmblemHealth Commercial	$28.74
Rate for Payer: Humana Medicare Advantage	$9.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.58
Rate for Payer: Wellcare Medicare Advantage	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

LUPUS ANTICOAGULANT

Facility

$107.00

Service Code	HCPCS 85613
Hospital Charge Code	38478074
Hospital Revenue Code	305
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

LUPUS DRVVT CONFIRM

Facility

$123.55

Service Code	HCPCS 85597
Hospital Charge Code	39900178
Hospital Revenue Code	305
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.22
Rate for Payer: Cigna Commercial	$61.77
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.12
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.53
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.51

LUPUS DRVVT CONFIRM

Facility

$123.55

Service Code	HCPCS 85597
Hospital Charge Code	39900178
Hospital Revenue Code	305
Min. Negotiated Rate	$18.53
Max. Negotiated Rate	$18.53
Rate for Payer: Qualcare PPO/HMO/WC	$18.53

LUPUS;HEX PHASE NEUT

Facility

$123.55

Service Code	HCPCS 85598
Hospital Charge Code	39900180
Hospital Revenue Code	305
Min. Negotiated Rate	$18.53
Max. Negotiated Rate	$18.53
Rate for Payer: Qualcare PPO/HMO/WC	$18.53

LUPUS;HEX PHASE NEUT

Facility

$123.55

Service Code	HCPCS 85598
Hospital Charge Code	39900180
Hospital Revenue Code	305
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.22
Rate for Payer: Cigna Commercial	$61.77
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.12
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.53
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.51

LUPUS PROFILE I

Facility

$667.59

Service Code	HCPCS 85613
Hospital Charge Code	39990077A
Hospital Revenue Code	305
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$26.06
Rate for Payer: Aetna Medicare Advantage	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.75
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$9.58
Rate for Payer: Clover Medicare Advantage	$9.10
Rate for Payer: EmblemHealth Commercial	$28.74
Rate for Payer: Humana Medicare Advantage	$9.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.58
Rate for Payer: Wellcare Medicare Advantage	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

LUPUS PROFILE I

Facility

$667.59

Service Code	HCPCS 85613
Hospital Charge Code	39990077A
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LUPUS PROFILE II

Facility

$667.59

Service Code	HCPCS 85730
Hospital Charge Code	39990077B
Hospital Revenue Code	305
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$16.35
Rate for Payer: Aetna Medicare Advantage	$19.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.80
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.01
Rate for Payer: Clover Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$6.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.01
Rate for Payer: Wellcare Medicare Advantage	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

LUPUS PROFILE II

Facility

$667.59

Service Code	HCPCS 85730
Hospital Charge Code	39990077B
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LUTEINIZING HORMONE (LH)

Facility

$633.00

Service Code	HCPCS 83002
Hospital Charge Code	38472467
Hospital Revenue Code	301
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$316.50
Rate for Payer: Aetna Commercial	$50.37
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.18
Rate for Payer: Cigna Commercial	$316.50
Rate for Payer: Cigna Medicare Advantage	$18.52
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.58
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Medicare Advantage	$18.52
Rate for Payer: Wellpoint Medicaid Managed Care	$17.98

LUTEINIZING HORMONE (LH)

Facility

$633.00

Service Code	HCPCS 83002
Hospital Charge Code	38472467
Hospital Revenue Code	301
Min. Negotiated Rate	$94.95
Max. Negotiated Rate	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$94.95

L VENTRIC PACING LEAD ADD ON

Facility

$27,941.00

Service Code	HCPCS 33225
Hospital Charge Code	411033225
Hospital Revenue Code	481
Min. Negotiated Rate	$793.52
Max. Negotiated Rate	$17,348.00
Rate for Payer: Aetna Commercial	$10,617.58
Rate for Payer: Aetna Medicare Advantage	$8,382.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,124.95
Rate for Payer: Cigna Commercial	$13,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,264.66
Rate for Payer: Oxford Commercial	$15,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,191.15
Rate for Payer: UnitedHealthcare Commercial	$17,348.00
Rate for Payer: UnitedHealthcare Community & State	$882.94
Rate for Payer: Wellpoint Medicaid Managed Care	$793.52

Know your out-of-pocket cost for care.

All Charges