Health Plan Costs: Jason Bourne

1. 4. Appendectomy surgery (in network) – w/o Cost $10,000 w/in $0 W/out $2000

2. 5. Prescription (brand) – Cost $185 cost with $10

3. 6. Eye exam (out of network)- Cost $454 w/in $10

4. 7. Urgent care visit for broken foot (out of network) - Cost $855 W/in $10 W/out $171

5. 8. Surgery for foot (out of network) – Cost $5400 W/in $0 W/out $1080

6. 9. Prescription (generic) - Cost $85 Cost $5

7. 10. Doctor’s visit for annual physical (out of network) - Cost $958 W/in $5

8. 11. Emergency room visit for snow board accident (concussion, broken leg, x-rays, etc.) – Cost $6,500 with $25

9. 12. Urgent care visit for shots (in network) - Cost $105 W/in $10 W/out $21

10. 1. Doctor’s office visit for cough (in network) –W/O Cost $95 W/In cost $5

11. 2. Emergency room visit for stitches – W/O cost $1,152 W/in $25

11.1. 3. Hospital stay for flu (out of network) –W/O Cost $1,500 W/in $0 w/out $300

12. 3. Hospital stay for flu (out of network) –W/O Cost $1,500 W/in $0 w/out $300