Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VAS ACCUCHECK

Facility

$56.00

Service Code	HCPCS 82948
Hospital Charge Code	7411762
Hospital Revenue Code	301
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

VAS ACCUCHECK

Facility

$56.00

Service Code	HCPCS 82948
Hospital Charge Code	34046801
Hospital Revenue Code	301
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$13.71
Rate for Payer: Aetna Medicare Advantage	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: Cigna Medicare Advantage	$5.04
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04
Rate for Payer: Wellcare Medicare Advantage	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

VAS ACCUCHECK

Facility

$56.00

Service Code	HCPCS 82948
Hospital Charge Code	34046801
Hospital Revenue Code	301
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

VASC BAND HEMOSTAT LARGE

Facility

$147.50

Hospital Charge Code	270677068
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$56.05
Rate for Payer: Aetna Medicare Advantage	$44.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.61
Rate for Payer: Cigna Commercial	$73.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$29.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.12
Rate for Payer: UnitedHealthcare Commercial	$29.50
Rate for Payer: UnitedHealthcare Community & State	$4.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

VASC BAND HEMOSTAT LARGE

Facility

$147.50

Hospital Charge Code	270677068
Hospital Revenue Code	272
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$22.12
Rate for Payer: Qualcare PPO/HMO/WC	$22.12

VASC BAND HEMOSTAT REGULAR

Facility

$14.75

Hospital Charge Code	270677067N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$5.61
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.83
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$2.95
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

VASC BAND HEMOSTAT REGULAR

Facility

$147.50

Hospital Charge Code	270677067S
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$56.05
Rate for Payer: Aetna Medicare Advantage	$44.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.61
Rate for Payer: Cigna Commercial	$73.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$29.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.12
Rate for Payer: UnitedHealthcare Commercial	$29.50
Rate for Payer: UnitedHealthcare Community & State	$4.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

VASC BAND HEMOSTAT REGULAR

Facility

$147.50

Hospital Charge Code	270677067
Hospital Revenue Code	272
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$22.12
Rate for Payer: Qualcare PPO/HMO/WC	$22.12

VASC BAND HEMOSTAT REGULAR

Facility

$14.75

Hospital Charge Code	270677067N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

VASC BAND HEMOSTAT REGULAR

Facility

$147.50

Hospital Charge Code	270677067S
Hospital Revenue Code	272
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$22.12
Rate for Payer: Qualcare PPO/HMO/WC	$22.12

VASC BAND HEMOSTAT REGULAR

Facility

$147.50

Hospital Charge Code	270677067
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$56.05
Rate for Payer: Aetna Medicare Advantage	$44.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.61
Rate for Payer: Cigna Commercial	$73.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$29.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.12
Rate for Payer: UnitedHealthcare Commercial	$29.50
Rate for Payer: UnitedHealthcare Community & State	$4.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$56,620.95

Service Code	HCPCS 37244
Hospital Charge Code	5700321
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$52,513.90

Service Code	HCPCS 37244
Hospital Charge Code	7411533
Hospital Revenue Code	361
Min. Negotiated Rate	$1,659.44
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,653.61
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,877.09
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,659.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,278.35
Rate for Payer: Wellpoint Medicaid Managed Care	$23,802.30

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$56,620.95

Service Code	HCPCS 37244
Hospital Charge Code	321037244
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$56,620.95

Service Code	HCPCS 37244
Hospital Charge Code	321037244
Hospital Revenue Code	361
Min. Negotiated Rate	$1,789.22
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,721.45
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,789.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,278.35
Rate for Payer: Wellpoint Medicaid Managed Care	$23,802.30

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$52,513.90

Service Code	HCPCS 37244
Hospital Charge Code	411037244
Hospital Revenue Code	361
Min. Negotiated Rate	$7,877.09
Max. Negotiated Rate	$7,877.09
Rate for Payer: Qualcare PPO/HMO/WC	$7,877.09

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$52,513.90

Service Code	HCPCS 37244
Hospital Charge Code	411037244
Hospital Revenue Code	361
Min. Negotiated Rate	$1,659.44
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,653.61
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,877.09
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,659.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,278.35
Rate for Payer: Wellpoint Medicaid Managed Care	$23,802.30

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$52,513.90

Service Code	HCPCS 37244
Hospital Charge Code	366837244
Hospital Revenue Code	361
Min. Negotiated Rate	$7,877.09
Max. Negotiated Rate	$7,877.09
Rate for Payer: Qualcare PPO/HMO/WC	$7,877.09

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$52,513.90

Service Code	HCPCS 37244
Hospital Charge Code	366837244
Hospital Revenue Code	361
Min. Negotiated Rate	$1,659.44
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,653.61
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,877.09
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,659.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,278.35
Rate for Payer: Wellpoint Medicaid Managed Care	$23,802.30

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$56,620.95

Service Code	HCPCS 37244
Hospital Charge Code	5700321
Hospital Revenue Code	361
Min. Negotiated Rate	$1,789.22
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,721.45
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,789.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,278.35
Rate for Payer: Wellpoint Medicaid Managed Care	$23,802.30

VASC EMBOLIZE/OCCL ARTERY HEMO

Facility

$52,513.90

Service Code	HCPCS 37244
Hospital Charge Code	7411533
Hospital Revenue Code	361
Min. Negotiated Rate	$7,877.09
Max. Negotiated Rate	$7,877.09
Rate for Payer: Qualcare PPO/HMO/WC	$7,877.09

VASC EMBOLIZE/OCCLUDE ARTERY

Facility

$52,513.90

Service Code	HCPCS 37242
Hospital Charge Code	7411530
Hospital Revenue Code	361
Min. Negotiated Rate	$7,877.09
Max. Negotiated Rate	$7,877.09
Rate for Payer: Qualcare PPO/HMO/WC	$7,877.09

VASC EMBOLIZE/OCCLUDE ARTERY

Facility

$57,352.09

Service Code	HCPCS 37242
Hospital Charge Code	4110935100
Hospital Revenue Code	481
Min. Negotiated Rate	$8,602.81
Max. Negotiated Rate	$8,602.81
Rate for Payer: Qualcare PPO/HMO/WC	$8,602.81

VASC EMBOLIZE/OCCLUDE ARTERY

Facility

$57,352.09

Service Code	HCPCS 37242
Hospital Charge Code	1600000864
Hospital Revenue Code	360
Min. Negotiated Rate	$1,628.80
Max. Negotiated Rate	$79,001.40
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79,001.40
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,911.54
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,602.81
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,812.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1,628.80

VASC EMBOLIZE/OCCLUDE ARTERY

Facility

$57,352.09

Service Code	HCPCS 37242
Hospital Charge Code	321037242
Hospital Revenue Code	361
Min. Negotiated Rate	$1,628.80
Max. Negotiated Rate	$79,001.40
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79,001.40
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,911.54
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,602.81
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,812.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1,628.80

Know your out-of-pocket cost for care.

All Charges