Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VEIN X-RAY TRUNK

Facility

$13,436.40

Service Code	HCPCS 75825
Hospital Charge Code	411075825
Hospital Revenue Code	320
Min. Negotiated Rate	$194.04
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$2,625.82
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,493.46
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,015.46
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$424.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$381.59

VEIN X-RAY TRUNK

Facility

$13,436.40

Service Code	HCPCS 75825
Hospital Charge Code	366875825
Hospital Revenue Code	320
Min. Negotiated Rate	$2,015.46
Max. Negotiated Rate	$2,015.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,015.46

VEIN X-RAY TRUNK

Facility

$13,436.40

Service Code	HCPCS 75825
Hospital Charge Code	366875825
Hospital Revenue Code	320
Min. Negotiated Rate	$194.04
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$2,625.82
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,493.46
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,015.46
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$424.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$381.59

Velocity Catheter

Facility

$5,285.00

Hospital Charge Code	270682974S
Hospital Revenue Code	272
Min. Negotiated Rate	$150.09
Max. Negotiated Rate	$2,642.50
Rate for Payer: Aetna Commercial	$2,008.30
Rate for Payer: Aetna Medicare Advantage	$1,585.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,347.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,347.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,347.67
Rate for Payer: Cigna Commercial	$2,642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.10
Rate for Payer: Oxford Commercial	$1,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$792.75
Rate for Payer: UnitedHealthcare Commercial	$1,057.00
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: Wellpoint Medicaid Managed Care	$150.09

Velocity Catheter

Facility

$5,285.00

Hospital Charge Code	270682974S
Hospital Revenue Code	272
Min. Negotiated Rate	$792.75
Max. Negotiated Rate	$792.75
Rate for Payer: Qualcare PPO/HMO/WC	$792.75

VELOCITY CATHETER

Facility

$5,285.00

Hospital Charge Code	270682974N
Hospital Revenue Code	272
Min. Negotiated Rate	$150.09
Max. Negotiated Rate	$2,642.50
Rate for Payer: Aetna Commercial	$2,008.30
Rate for Payer: Aetna Medicare Advantage	$1,585.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,347.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,347.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,347.67
Rate for Payer: Cigna Commercial	$2,642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.10
Rate for Payer: Oxford Commercial	$1,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$792.75
Rate for Payer: UnitedHealthcare Commercial	$1,057.00
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: Wellpoint Medicaid Managed Care	$150.09

VELOCITY CATHETER

Facility

$5,285.00

Hospital Charge Code	270682974N
Hospital Revenue Code	272
Min. Negotiated Rate	$792.75
Max. Negotiated Rate	$792.75
Rate for Payer: Qualcare PPO/HMO/WC	$792.75

VENA CAVA FILTER

Facility

$21.40

Service Code	HCPCS C1880
Hospital Charge Code	4800890
Hospital Revenue Code	278
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$10.70
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna Medicare Advantage	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.46
Rate for Payer: Cigna Commercial	$10.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

VENA CAVA FILTER

Facility

$21.40

Service Code	HCPCS C1880
Hospital Charge Code	4800890
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

VENA CAVA FILTER, GREENFIELD

Facility

$3,270.00

Service Code	HCPCS C1880
Hospital Charge Code	2008125
Hospital Revenue Code	278
Min. Negotiated Rate	$92.87
Max. Negotiated Rate	$1,635.00
Rate for Payer: Aetna Commercial	$1,242.60
Rate for Payer: Aetna Medicare Advantage	$981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$833.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$833.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$654.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$833.85
Rate for Payer: Cigna Commercial	$1,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$791.34
Rate for Payer: Qualcare PPO/HMO/WC	$490.50
Rate for Payer: UnitedHealthcare Community & State	$103.33
Rate for Payer: Wellpoint Medicaid Managed Care	$92.87

VENA CAVA FILTER, GREENFIELD

Facility

$3,270.00

Service Code	HCPCS C1880
Hospital Charge Code	2008125
Hospital Revenue Code	278
Min. Negotiated Rate	$490.50
Max. Negotiated Rate	$791.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$654.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$791.34
Rate for Payer: Qualcare PPO/HMO/WC	$490.50

VENIP CUTDOWN 1 YR OR OLDER

Facility

$109.00

Service Code	HCPCS 36425
Hospital Charge Code	5770025
Hospital Revenue Code	450
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$1,925.19
Rate for Payer: Aetna Commercial	$1,443.56
Rate for Payer: Aetna Medicare Advantage	$1,719.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,925.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,925.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$530.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,925.19
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: Cigna Medicare Advantage	$530.72
Rate for Payer: Clover Medicare Advantage	$504.18
Rate for Payer: EmblemHealth Commercial	$1,592.16
Rate for Payer: Humana Medicare Advantage	$546.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$530.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Qualcare PPO/HMO/WC	$16.35
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$530.72
Rate for Payer: Wellcare Medicare Advantage	$530.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

VENIP CUTDOWN 1 YR OR OLDER

Facility

$109.00

Service Code	HCPCS 36425
Hospital Charge Code	5770025
Hospital Revenue Code	450
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$16.35
Rate for Payer: Qualcare PPO/HMO/WC	$16.35

VENIPUNC NEO/PEDS/NURSERYI&2

Facility

$97.00

Service Code	HCPCS 36416
Hospital Charge Code	83033010
Hospital Revenue Code	300
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.22
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$2.75

VENIPUNC NEO/PEDS/NURSERYI&2

Facility

$97.00

Service Code	HCPCS 36416
Hospital Charge Code	83033010
Hospital Revenue Code	300
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	87502770
Hospital Revenue Code	300
Min. Negotiated Rate	$20.37
Max. Negotiated Rate	$20.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.37

VENIPUNCTURE

Facility

$646.22

Service Code	HCPCS 36415
Hospital Charge Code	3008604
Hospital Revenue Code	300
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$323.11
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.88
Rate for Payer: Cigna Commercial	$323.11
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.93
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$18.35

VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	87502770
Hospital Revenue Code	300
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.88
Rate for Payer: Cigna Commercial	$67.90
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.31
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.37
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	83653001
Hospital Revenue Code	300
Min. Negotiated Rate	$20.37
Max. Negotiated Rate	$20.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.37

VENIPUNCTURE

Facility

$15.00

Service Code	HCPCS 36415
Hospital Charge Code	93500139
Hospital Revenue Code	300
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	83653001
Hospital Revenue Code	300
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.88
Rate for Payer: Cigna Commercial	$67.90
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.31
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.37
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

VENIPUNCTURE

Facility

$646.22

Service Code	HCPCS 36415
Hospital Charge Code	3008604
Hospital Revenue Code	300
Min. Negotiated Rate	$96.93
Max. Negotiated Rate	$96.93
Rate for Payer: Qualcare PPO/HMO/WC	$96.93

VENIPUNCTURE

Facility

$15.00

Service Code	HCPCS 36415
Hospital Charge Code	93500139
Hospital Revenue Code	300
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.88
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

VENIPUNCTURE ACCES DEVICE PERM

Facility

$253.75

Service Code	HCPCS 36591
Hospital Charge Code	83033001
Hospital Revenue Code	361
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.97
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.06
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$8.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.21

VENIPUNCTURE ACCES DEVICE PERM

Facility

$253.75

Service Code	HCPCS 36591
Hospital Charge Code	83033001
Hospital Revenue Code	361
Min. Negotiated Rate	$38.06
Max. Negotiated Rate	$38.06
Rate for Payer: Qualcare PPO/HMO/WC	$38.06

Know your out-of-pocket cost for care.

All Charges