White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$40,188.80

Service Code	MSDRG 135
Min. Negotiated Rate	$18,508.00
Max. Negotiated Rate	$40,188.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,664.06
Rate for Payer: Amerigroup Medicare	$20,664.06
Rate for Payer: BCBS of TX Medicare	$20,664.06
Rate for Payer: Cigna Commercial	$27,243.78
Rate for Payer: Cigna Medicare	$20,664.06
Rate for Payer: Employer Direct Commercial	$20,664.06
Rate for Payer: Humana Medicare/TRICARE	$20,664.06
Rate for Payer: Molina Dual Medicare/Medicaid	$20,664.06
Rate for Payer: Molina Medicare	$20,664.06
Rate for Payer: Multiplan Auto	$40,188.80
Rate for Payer: Multiplan Commercial	$40,188.80
Rate for Payer: Multiplan Workers Comp	$40,188.80
Rate for Payer: Scott and White EPO/PPO	$18,508.00
Rate for Payer: Scott and White Medicare	$20,664.06
Rate for Payer: Superior Health Plan EPO	$20,664.06
Rate for Payer: Superior Health Plan Medicare	$20,664.06
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,664.06
Rate for Payer: Universal American Medicare	$20,664.06
Rate for Payer: Wellcare Medicare	$20,664.06
Rate for Payer: Wellmed Medicare	$20,664.06

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$19,290.70

Service Code	MSDRG 136
Min. Negotiated Rate	$8,883.88
Max. Negotiated Rate	$19,290.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,201.24
Rate for Payer: Amerigroup Medicare	$12,201.24
Rate for Payer: BCBS of TX Medicare	$12,201.24
Rate for Payer: Cigna Commercial	$13,077.06
Rate for Payer: Cigna Medicare	$12,201.24
Rate for Payer: Employer Direct Commercial	$12,201.24
Rate for Payer: Humana Medicare/TRICARE	$12,201.24
Rate for Payer: Molina Dual Medicare/Medicaid	$12,201.24
Rate for Payer: Molina Medicare	$12,201.24
Rate for Payer: Multiplan Auto	$19,290.70
Rate for Payer: Multiplan Commercial	$19,290.70
Rate for Payer: Multiplan Workers Comp	$19,290.70
Rate for Payer: Scott and White EPO/PPO	$8,883.88
Rate for Payer: Scott and White Medicare	$12,201.24
Rate for Payer: Superior Health Plan EPO	$12,201.24
Rate for Payer: Superior Health Plan Medicare	$12,201.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,201.24
Rate for Payer: Universal American Medicare	$12,201.24
Rate for Payer: Wellcare Medicare	$12,201.24
Rate for Payer: Wellmed Medicare	$12,201.24

SINUS & MASTOID PROCEDURES W CC/MCC

Facility

$40,188.80

Service Code	MSDRG 135
Min. Negotiated Rate	$18,508.00
Max. Negotiated Rate	$40,188.80
Rate for Payer: BCBS of TX Blue Advantage	$19,764.52
Rate for Payer: BCBS of TX Blue Essentials	$23,715.13
Rate for Payer: BCBS of TX PPO	$26,351.16

SINUS & MASTOID PROCEDURES W/O CC/MCC

Facility

$19,290.70

Service Code	MSDRG 136
Min. Negotiated Rate	$8,883.88
Max. Negotiated Rate	$19,290.70
Rate for Payer: BCBS of TX Blue Advantage	$10,427.50
Rate for Payer: BCBS of TX Blue Essentials	$12,511.79
Rate for Payer: BCBS of TX PPO	$13,902.52

Sirolimus (Rapamune), Blood SO

Facility

$192.35

Service Code	HCPCS 80195
Hospital Charge Code	4150253
Hospital Revenue Code	301
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$138.49
Rate for Payer: Amerigroup CHIP/Medicaid	$5.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.73
Rate for Payer: Amerigroup Medicare	$13.73
Rate for Payer: BCBS of TX Blue Advantage	$57.70
Rate for Payer: BCBS of TX Blue Essentials	$69.25
Rate for Payer: BCBS of TX Medicare	$13.73
Rate for Payer: BCBS of TX PPO	$76.94
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cigna Medicaid	$138.49
Rate for Payer: Cigna Medicare	$13.73
Rate for Payer: Employer Direct Commercial	$13.73
Rate for Payer: Humana Medicare/TRICARE	$13.73
Rate for Payer: Molina CHIP/Medicaid	$138.49
Rate for Payer: Molina Dual Medicare/Medicaid	$13.73
Rate for Payer: Molina Medicare	$13.73
Rate for Payer: Multiplan Auto	$125.03
Rate for Payer: Multiplan Commercial	$125.03
Rate for Payer: Multiplan Workers Comp	$125.03
Rate for Payer: Parkland Medicaid	$138.49
Rate for Payer: Scott and White EPO/PPO	$17.16
Rate for Payer: Scott and White Medicare	$13.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$138.49
Rate for Payer: Superior Health Plan EPO	$13.73
Rate for Payer: Superior Health Plan Medicare	$13.73
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.73
Rate for Payer: Universal American Medicare	$13.73
Rate for Payer: Wellcare Medicare	$13.73
Rate for Payer: Wellmed Medicare	$13.73

Sirolimus (Rapamune), Blood SO

Facility

$192.35

Service Code	HCPCS 80195
Hospital Charge Code	9048977
Hospital Revenue Code	301
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$138.49
Rate for Payer: Amerigroup CHIP/Medicaid	$5.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.73
Rate for Payer: Amerigroup Medicare	$13.73
Rate for Payer: BCBS of TX Blue Advantage	$57.70
Rate for Payer: BCBS of TX Blue Essentials	$69.25
Rate for Payer: BCBS of TX Medicare	$13.73
Rate for Payer: BCBS of TX PPO	$76.94
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cigna Medicaid	$138.49
Rate for Payer: Cigna Medicare	$13.73
Rate for Payer: Employer Direct Commercial	$13.73
Rate for Payer: Humana Medicare/TRICARE	$13.73
Rate for Payer: Molina CHIP/Medicaid	$138.49
Rate for Payer: Molina Dual Medicare/Medicaid	$13.73
Rate for Payer: Molina Medicare	$13.73
Rate for Payer: Multiplan Auto	$125.03
Rate for Payer: Multiplan Commercial	$125.03
Rate for Payer: Multiplan Workers Comp	$125.03
Rate for Payer: Parkland Medicaid	$138.49
Rate for Payer: Scott and White EPO/PPO	$17.16
Rate for Payer: Scott and White Medicare	$13.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$138.49
Rate for Payer: Superior Health Plan EPO	$13.73
Rate for Payer: Superior Health Plan Medicare	$13.73
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.73
Rate for Payer: Universal American Medicare	$13.73
Rate for Payer: Wellcare Medicare	$13.73
Rate for Payer: Wellmed Medicare	$13.73

Sirolimus (Rapamune), Blood SO

Facility

$192.35

Service Code	HCPCS 80195
Hospital Charge Code	4150253
Hospital Revenue Code	301
Rate for Payer: Cash Price	$130.80

Sirolimus (Rapamune), Blood SO

Facility

$192.35

Service Code	HCPCS 80195
Hospital Charge Code	9048977
Hospital Revenue Code	301
Rate for Payer: Cash Price	$130.80

Site-Rite Ultrasound Needle Guide Kit, 21g, 48' x 6' Probe Cover, No Taper, 1 cm/1.5 cm/2 cm Depths

Facility

$2,079.32

Hospital Charge Code	993082
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,413.94

Site-Rite Ultrasound Needle Guide Kit, 21g, 48' x 6' Probe Cover, No Taper, 1 cm/1.5 cm/2 cm Depths

Facility

$2,079.32

Hospital Charge Code	993082
Hospital Revenue Code	270
Min. Negotiated Rate	$187.14
Max. Negotiated Rate	$1,497.11
Rate for Payer: Amerigroup CHIP/Medicaid	$187.14
Rate for Payer: BCBS of TX Blue Advantage	$623.80
Rate for Payer: BCBS of TX Blue Essentials	$748.56
Rate for Payer: BCBS of TX PPO	$831.73
Rate for Payer: Cash Price	$1,413.94
Rate for Payer: Cigna Medicaid	$1,497.11
Rate for Payer: Molina CHIP/Medicaid	$1,497.11
Rate for Payer: Multiplan Auto	$1,351.56
Rate for Payer: Multiplan Commercial	$1,351.56
Rate for Payer: Multiplan Workers Comp	$1,351.56
Rate for Payer: Parkland Medicaid	$1,497.11
Rate for Payer: Scott and White EPO/PPO	$1,039.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,497.11
Rate for Payer: Superior Health Plan EPO	$282.79

Site-Rite Ultrasound Needle Guide Kit, 21G, 96' x 6' Probe Cover, 6'-3 Taper, 1 cm/1.5 cm/2 cm Depths

Facility

$122.16

Hospital Charge Code	993071
Hospital Revenue Code	270
Rate for Payer: Cash Price	$83.07

Site-Rite Ultrasound Needle Guide Kit, 21G, 96' x 6' Probe Cover, 6'-3 Taper, 1 cm/1.5 cm/2 cm Depths

Facility

$122.16

Hospital Charge Code	993071
Hospital Revenue Code	270
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$87.96
Rate for Payer: Amerigroup CHIP/Medicaid	$10.99
Rate for Payer: BCBS of TX Blue Advantage	$36.65
Rate for Payer: BCBS of TX Blue Essentials	$43.98
Rate for Payer: BCBS of TX PPO	$48.86
Rate for Payer: Cash Price	$83.07
Rate for Payer: Cigna Medicaid	$87.96
Rate for Payer: Molina CHIP/Medicaid	$87.96
Rate for Payer: Multiplan Auto	$79.40
Rate for Payer: Multiplan Commercial	$79.40
Rate for Payer: Multiplan Workers Comp	$79.40
Rate for Payer: Parkland Medicaid	$87.96
Rate for Payer: Scott and White EPO/PPO	$61.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.96
Rate for Payer: Superior Health Plan EPO	$16.61

SIZER BREAST IMPLANT

Facility

$1,265.00

Service Code	HCPCS C1789
Hospital Charge Code	82402025
Hospital Revenue Code	278
Min. Negotiated Rate	$316.25
Max. Negotiated Rate	$632.50
Rate for Payer: Cash Price	$860.20
Rate for Payer: Cigna Commercial	$316.25
Rate for Payer: Multiplan Auto	$632.50
Rate for Payer: Multiplan Commercial	$632.50
Rate for Payer: Multiplan Workers Comp	$632.50
Rate for Payer: Scott and White EPO/PPO	$632.50

SIZER BREAST IMPLANT

Facility

$1,265.00

Service Code	HCPCS C1789
Hospital Charge Code	82402025
Hospital Revenue Code	278
Min. Negotiated Rate	$113.85
Max. Negotiated Rate	$910.80
Rate for Payer: Amerigroup CHIP/Medicaid	$113.85
Rate for Payer: BCBS of TX Blue Advantage	$379.50
Rate for Payer: BCBS of TX Blue Essentials	$455.40
Rate for Payer: BCBS of TX PPO	$506.00
Rate for Payer: Cash Price	$860.20
Rate for Payer: Cigna Medicaid	$910.80
Rate for Payer: Molina CHIP/Medicaid	$910.80
Rate for Payer: Multiplan Auto	$632.50
Rate for Payer: Multiplan Commercial	$632.50
Rate for Payer: Multiplan Workers Comp	$632.50
Rate for Payer: Parkland Medicaid	$910.80
Rate for Payer: Scott and White EPO/PPO	$632.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$910.80
Rate for Payer: Superior Health Plan EPO	$172.04

SKIN CLOS 1/4 -- DHF

Facility

$55.15

Hospital Charge Code	81850653
Hospital Revenue Code	272
Rate for Payer: Cash Price	$37.50

SKIN CLOS 1/4 -- DHF

Facility

$55.15

Hospital Charge Code	81850653
Hospital Revenue Code	272
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$39.71
Rate for Payer: Amerigroup CHIP/Medicaid	$4.96
Rate for Payer: BCBS of TX Blue Advantage	$16.55
Rate for Payer: BCBS of TX Blue Essentials	$19.85
Rate for Payer: BCBS of TX PPO	$22.06
Rate for Payer: Cash Price	$37.50
Rate for Payer: Cigna Medicaid	$39.71
Rate for Payer: Molina CHIP/Medicaid	$39.71
Rate for Payer: Multiplan Auto	$35.85
Rate for Payer: Multiplan Commercial	$35.85
Rate for Payer: Multiplan Workers Comp	$35.85
Rate for Payer: Parkland Medicaid	$39.71
Rate for Payer: Scott and White EPO/PPO	$27.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.71
Rate for Payer: Superior Health Plan EPO	$7.50

SKIN DEBRIDEMENT W CC

Facility

$32,100.50

Service Code	MSDRG 571
Min. Negotiated Rate	$14,644.94
Max. Negotiated Rate	$32,100.50
Rate for Payer: BCBS of TX Blue Advantage	$14,644.94
Rate for Payer: BCBS of TX Blue Essentials	$17,572.23
Rate for Payer: BCBS of TX PPO	$19,525.45

SKIN DEBRIDEMENT WITH CC

Facility

$32,100.50

Service Code	MSDRG 571
Min. Negotiated Rate	$14,644.94
Max. Negotiated Rate	$32,100.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,142.48
Rate for Payer: Amerigroup Medicare	$17,142.48
Rate for Payer: BCBS of TX Medicare	$17,142.48
Rate for Payer: Cigna Commercial	$21,760.76
Rate for Payer: Cigna Medicare	$17,142.48
Rate for Payer: Employer Direct Commercial	$17,142.48
Rate for Payer: Humana Medicare/TRICARE	$17,142.48
Rate for Payer: Molina Dual Medicare/Medicaid	$17,142.48
Rate for Payer: Molina Medicare	$17,142.48
Rate for Payer: Multiplan Auto	$32,100.50
Rate for Payer: Multiplan Commercial	$32,100.50
Rate for Payer: Multiplan Workers Comp	$32,100.50
Rate for Payer: Scott and White EPO/PPO	$14,783.12
Rate for Payer: Scott and White Medicare	$17,142.48
Rate for Payer: Superior Health Plan EPO	$17,142.48
Rate for Payer: Superior Health Plan Medicare	$17,142.48
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,142.48
Rate for Payer: Universal American Medicare	$17,142.48
Rate for Payer: Wellcare Medicare	$17,142.48
Rate for Payer: Wellmed Medicare	$17,142.48

SKIN DEBRIDEMENT WITH MCC

Facility

$55,880.90

Service Code	MSDRG 570
Min. Negotiated Rate	$25,734.62
Max. Negotiated Rate	$55,880.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26,315.48
Rate for Payer: Amerigroup Medicare	$26,315.48
Rate for Payer: BCBS of TX Medicare	$26,315.48
Rate for Payer: Cigna Commercial	$37,881.37
Rate for Payer: Cigna Medicare	$26,315.48
Rate for Payer: Employer Direct Commercial	$26,315.48
Rate for Payer: Humana Medicare/TRICARE	$26,315.48
Rate for Payer: Molina Dual Medicare/Medicaid	$26,315.48
Rate for Payer: Molina Medicare	$26,315.48
Rate for Payer: Multiplan Auto	$55,880.90
Rate for Payer: Multiplan Commercial	$55,880.90
Rate for Payer: Multiplan Workers Comp	$55,880.90
Rate for Payer: Scott and White EPO/PPO	$25,734.62
Rate for Payer: Scott and White Medicare	$26,315.48
Rate for Payer: Superior Health Plan EPO	$26,315.48
Rate for Payer: Superior Health Plan Medicare	$26,315.48
Rate for Payer: Universal American Dual Medicare/Medicaid	$26,315.48
Rate for Payer: Universal American Medicare	$26,315.48
Rate for Payer: Wellcare Medicare	$26,315.48
Rate for Payer: Wellmed Medicare	$26,315.48

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$21,779.70

Service Code	MSDRG 572
Min. Negotiated Rate	$10,030.12
Max. Negotiated Rate	$21,779.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,161.34
Rate for Payer: Amerigroup Medicare	$13,161.34
Rate for Payer: BCBS of TX Medicare	$13,161.34
Rate for Payer: Cigna Commercial	$14,764.34
Rate for Payer: Cigna Medicare	$13,161.34
Rate for Payer: Employer Direct Commercial	$13,161.34
Rate for Payer: Humana Medicare/TRICARE	$13,161.34
Rate for Payer: Molina Dual Medicare/Medicaid	$13,161.34
Rate for Payer: Molina Medicare	$13,161.34
Rate for Payer: Multiplan Auto	$21,779.70
Rate for Payer: Multiplan Commercial	$21,779.70
Rate for Payer: Multiplan Workers Comp	$21,779.70
Rate for Payer: Scott and White EPO/PPO	$10,030.12
Rate for Payer: Scott and White Medicare	$13,161.34
Rate for Payer: Superior Health Plan EPO	$13,161.34
Rate for Payer: Superior Health Plan Medicare	$13,161.34
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,161.34
Rate for Payer: Universal American Medicare	$13,161.34
Rate for Payer: Wellcare Medicare	$13,161.34
Rate for Payer: Wellmed Medicare	$13,161.34

SKIN DEBRIDEMENT W MCC

Facility

$55,880.90

Service Code	MSDRG 570
Min. Negotiated Rate	$25,734.62
Max. Negotiated Rate	$55,880.90
Rate for Payer: BCBS of TX Blue Advantage	$26,098.42
Rate for Payer: BCBS of TX Blue Essentials	$31,315.07
Rate for Payer: BCBS of TX PPO	$34,795.87

SKIN DEBRIDEMENT W/O CC/MCC

Facility

$21,779.70

Service Code	MSDRG 572
Min. Negotiated Rate	$10,030.12
Max. Negotiated Rate	$21,779.70
Rate for Payer: BCBS of TX Blue Advantage	$10,135.96
Rate for Payer: BCBS of TX Blue Essentials	$12,161.97
Rate for Payer: BCBS of TX PPO	$13,513.83

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$50,363.30

Service Code	MSDRG 577
Min. Negotiated Rate	$21,579.12
Max. Negotiated Rate	$50,363.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24,187.13
Rate for Payer: Amerigroup Medicare	$24,187.13
Rate for Payer: BCBS of TX Medicare	$24,187.13
Rate for Payer: Cigna Commercial	$34,141.02
Rate for Payer: Cigna Medicare	$24,187.13
Rate for Payer: Employer Direct Commercial	$24,187.13
Rate for Payer: Humana Medicare/TRICARE	$24,187.13
Rate for Payer: Molina Dual Medicare/Medicaid	$24,187.13
Rate for Payer: Molina Medicare	$24,187.13
Rate for Payer: Multiplan Auto	$50,363.30
Rate for Payer: Multiplan Commercial	$50,363.30
Rate for Payer: Multiplan Workers Comp	$50,363.30
Rate for Payer: Scott and White EPO/PPO	$23,193.62
Rate for Payer: Scott and White Medicare	$24,187.13
Rate for Payer: Superior Health Plan EPO	$24,187.13
Rate for Payer: Superior Health Plan Medicare	$24,187.13
Rate for Payer: Universal American Dual Medicare/Medicaid	$24,187.13
Rate for Payer: Universal American Medicare	$24,187.13
Rate for Payer: Wellcare Medicare	$24,187.13
Rate for Payer: Wellmed Medicare	$24,187.13

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$93,122.80

Service Code	MSDRG 576
Min. Negotiated Rate	$40,681.11
Max. Negotiated Rate	$93,122.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$40,681.11
Rate for Payer: Amerigroup Medicare	$40,681.11
Rate for Payer: BCBS of TX Medicare	$40,681.11
Rate for Payer: Cigna Commercial	$63,127.46
Rate for Payer: Cigna Medicare	$40,681.11
Rate for Payer: Employer Direct Commercial	$40,681.11
Rate for Payer: Humana Medicare/TRICARE	$40,681.11
Rate for Payer: Molina Dual Medicare/Medicaid	$40,681.11
Rate for Payer: Molina Medicare	$40,681.11
Rate for Payer: Multiplan Auto	$93,122.80
Rate for Payer: Multiplan Commercial	$93,122.80
Rate for Payer: Multiplan Workers Comp	$93,122.80
Rate for Payer: Scott and White EPO/PPO	$42,885.50
Rate for Payer: Scott and White Medicare	$40,681.11
Rate for Payer: Superior Health Plan EPO	$40,681.11
Rate for Payer: Superior Health Plan Medicare	$40,681.11
Rate for Payer: Universal American Dual Medicare/Medicaid	$40,681.11
Rate for Payer: Universal American Medicare	$40,681.11
Rate for Payer: Wellcare Medicare	$40,681.11
Rate for Payer: Wellmed Medicare	$40,681.11

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$30,521.60

Service Code	MSDRG 578
Min. Negotiated Rate	$13,155.42
Max. Negotiated Rate	$30,521.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,533.43
Rate for Payer: Amerigroup Medicare	$16,533.43
Rate for Payer: BCBS of TX Medicare	$16,533.43
Rate for Payer: Cigna Commercial	$20,690.43
Rate for Payer: Cigna Medicare	$16,533.43
Rate for Payer: Employer Direct Commercial	$16,533.43
Rate for Payer: Humana Medicare/TRICARE	$16,533.43
Rate for Payer: Molina Dual Medicare/Medicaid	$16,533.43
Rate for Payer: Molina Medicare	$16,533.43
Rate for Payer: Multiplan Auto	$30,521.60
Rate for Payer: Multiplan Commercial	$30,521.60
Rate for Payer: Multiplan Workers Comp	$30,521.60
Rate for Payer: Scott and White EPO/PPO	$14,056.00
Rate for Payer: Scott and White Medicare	$16,533.43
Rate for Payer: Superior Health Plan EPO	$16,533.43
Rate for Payer: Superior Health Plan Medicare	$16,533.43
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,533.43
Rate for Payer: Universal American Medicare	$16,533.43
Rate for Payer: Wellcare Medicare	$16,533.43
Rate for Payer: Wellmed Medicare	$16,533.43

Know your out-of-pocket cost for care.

All Charges