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


Provider
Billing Charges
Member
Cost
Savings on Member Plan
Savings
Percentage
Actual EOB
X-Ray Shoulder
CT Thorax
Ultrasound -
Pelvic
Ultrasound - Vascular
Ultrasound
Surgery
Pulmonary
Eye Surgery
OB GYN Visit
Pediatrics
Dermatology
MRI Full
$222.72
Clinic
Urgent Care
Provider
Billing Charges
Member
Cost
Savings on Discount Plan
Savings
Percantage
Actual EOB
Med Post Urgent Care
South West Urgent Care
Upper Valley Urgent Care
Labs

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
Quest Diagnostic
LabCorp
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