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What YOU Would Pay
60/40 Plan
No Copays
No Deductibles

What would YOU Pay 29 Jun 2021.jpg
Provider
Billing Charges
Member
Cost
Savings on Member Plan
Savings
Percentage
Actual EOB

X-Ray Shoulder

$88.80

$13.51

$75.29

85%

CT Thorax

$822.00

$113.34

$708.66

86%

Ultrasound -

Pelvic

$565.00

$123.72

$441.28

78%

Ultrasound - Vascular

$338.00

$53.47

$284.53

84%

Ultrasound

$164.00

$12.72

$151.28

92%

Surgery

$24,500.00

$1,837.50

$22,662.50

93%

Pulmonary

$467.00

$69.70

$397.30

85%

Eye Surgery

$3,382.00

$402.93

$2,979.07

88%

OB GYN Visit

$104.00

$13.32

$90.68

87%

Pediatrics

$255.00

$37.12

$217.88

85%

Dermatology

$130.00

$20.07

$109.93

85%

MRI Full

$222.72

$1,382.00

$1,159.28

84%

Clinic

$305.48

$58.00

$247.48

81%

Urgent Care YOU Pay 29 June 2021.jpg

Urgent Care

Provider
Billing Charges
Member
Cost
Savings on Discount Plan
Savings
Percantage
Actual EOB

Med Post Urgent Care

$320.00

$96.00

$224.00

70%

South West Urgent Care 

$384.00

$49.98

$334.02

87%

Upper Valley Urgent Care

$375.00

$65.95

$309.05

82%

Labs

Labs YOU Pay 29 June 2021.jpg
Provider
Billing Charges
Negotiated Contract Rate
Member
Cost
Savings on Discount Plan
Savings
Percantage
Actual EOB

Quest Labs 

$52.87

$2.27

$50.60

96%

LabCorp

$215.00

$19.90

$195.10

91%

Quest Diagnostic

$549.90

$18.91

$530.99

97%

LabCorp

$1,101.00

$76.53

$1,024.47

93%

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