Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]

Facility

$0.84

Service Code	NDC 62135-191-22
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Cash Price	$0.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Commercial	$0.63

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]

Facility

$1.68

Service Code	NDC 68084-479-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Cash Price	$0.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Commercial	$1.26

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]

Facility

$0.30

Service Code	NDC 23155-531-02
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.16
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.24
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Commercial	$0.23

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]

Facility

$1.22

Service Code	NDC 0904-7119-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.98
Rate for Payer: Cash Price	$0.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.98
Rate for Payer: Health Smart Auto/Commercial	$0.73
Rate for Payer: LLUH Dept of Risk Management WC	$0.67
Rate for Payer: Multiplan Commercial	$0.92

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]

Facility

$0.84

Service Code	NDC 62135-191-22
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.50
Rate for Payer: Aetna of CA Government/Medicare	$0.50
Rate for Payer: Cash Price	$0.46
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.67
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Commercial	$0.63

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE [30961]

Facility

$1.68

Service Code	NDC 68084-479-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Commercial	$1.26

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [111161]

Facility

$2.43

Service Code	HCPCS J0618
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.46
Rate for Payer: Aetna of CA Government/Medicare	$1.46
Rate for Payer: Cash Price	$1.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.94
Rate for Payer: Health Smart Auto/Commercial	$1.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.46
Rate for Payer: LLUH Dept of Risk Management WC	$1.34
Rate for Payer: Multiplan Commercial	$1.82

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [111161]

Facility

$2.43

Service Code	HCPCS J0618
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.94
Rate for Payer: Health Smart Auto/Commercial	$1.46
Rate for Payer: LLUH Dept of Risk Management WC	$1.34
Rate for Payer: Multiplan Commercial	$1.82

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE [1306]

Facility

$1.08

Service Code	HCPCS J0618
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cash Price	$0.69
Rate for Payer: Cash Price	$0.83
Rate for Payer: Cash Price	$1.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.21
Rate for Payer: Health Smart Auto/Commercial	$1.23
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.91
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Commercial	$1.54
Rate for Payer: Multiplan Commercial	$1.13
Rate for Payer: Multiplan Commercial	$0.95
Rate for Payer: Multiplan Commercial	$0.81

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE [1306]

Facility

$1.08

Service Code	HCPCS J0618
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.91
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.23
Rate for Payer: Aetna of CA Government/Medicare	$1.23
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.65
Rate for Payer: Aetna of CA Government/Medicare	$0.91
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cash Price	$1.13
Rate for Payer: Cash Price	$0.69
Rate for Payer: Cash Price	$0.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.64
Rate for Payer: Health Smart Auto/Commercial	$1.23
Rate for Payer: Health Smart Auto/Commercial	$0.91
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.65
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.59
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Commercial	$0.95
Rate for Payer: Multiplan Commercial	$1.13
Rate for Payer: Multiplan Commercial	$1.54
Rate for Payer: Multiplan Commercial	$0.81

CALCIUM CHLORIDE 10% 1 G/10 ML SYRINGE - CODE [4080563]

Facility

$2.05

Service Code	HCPCS J0618
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.91
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$1.23
Rate for Payer: Aetna of CA Government/Medicare	$0.91
Rate for Payer: Cash Price	$0.69
Rate for Payer: Cash Price	$1.13
Rate for Payer: Cash Price	$0.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.21
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.91
Rate for Payer: Health Smart Auto/Commercial	$1.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: Multiplan Commercial	$0.95
Rate for Payer: Multiplan Commercial	$1.13
Rate for Payer: Multiplan Commercial	$1.54

CALCIUM CHLORIDE 10% 1 G/10 ML SYRINGE - CODE [4080563]

Facility

$2.05

Service Code	HCPCS J0618
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.64
Rate for Payer: Cash Price	$1.13
Rate for Payer: Cash Price	$0.69
Rate for Payer: Cash Price	$0.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.91
Rate for Payer: Health Smart Auto/Commercial	$1.23
Rate for Payer: LLUH Dept of Risk Management WC	$1.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Commercial	$0.95
Rate for Payer: Multiplan Commercial	$1.13
Rate for Payer: Multiplan Commercial	$1.54

CALCIUM CHLORIDE ORAL SOLN (IV FORM) 100 MG/ML [4080423]

Facility

$0.24

Service Code	NDC 9994-0804-23
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18

CALCIUM CHLORIDE ORAL SOLN (IV FORM) 100 MG/ML [4080423]

Facility

$0.24

Service Code	NDC 9994-0804-23
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.13
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.19
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.18

CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]

Facility

$1.20

Service Code	HCPCS J0612
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]

Facility

$1.20

Service Code	HCPCS J0612
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

CALCIUM GLUCONATE 10% 1 G/10 ML VIAL - CODE [4080582]

Facility

$1.20

Service Code	HCPCS J0612
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

CALCIUM GLUCONATE 10% 1 G/10 ML VIAL - CODE [4080582]

Facility

$1.20

Service Code	HCPCS J0612
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

CALCIUM GLUCONATE 1 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION [232808]

Facility

$0.15

Service Code	HCPCS J0613
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

CALCIUM GLUCONATE 1 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION [232808]

Facility

$0.15

Service Code	HCPCS J0613
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.11

CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION [225276]

Facility

$0.47

Service Code	HCPCS J0613
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Commercial	$0.35

CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION [225276]

Facility

$0.47

Service Code	HCPCS J0613
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Commercial	$0.35

CALCIUM GLUCONATE 50 MG/ML (5%) IV [4080945]

Facility

$0.04

Service Code	HCPCS J0612
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

CALCIUM GLUCONATE 50 MG/ML (5%) IV [4080945]

Facility

$0.04

Service Code	HCPCS J0612
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

CALCIUM GLUCONATE ORAL SOLUTION (IV FORM) 100 MG/ML [4080424]

Facility

$0.06

Service Code	NDC 9994-0804-24
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.05

Know your out-of-pocket cost for care.

All Charges