Health Plan Cost- Dalia Garza

1. 4. Appendectomy surgery (in network) – Cost $10,000

1.1. In network pay pay nothing

2. 5. Prescription (brand) – Cost $185

2.1. Pay $10

3. 6. Eye exam (out of network)- Cost $454

3.1. Out of Network pay 20% of cost

4. 7. Urgent care visit for broken foot (out of network) - Cost $855

4.1. Out of Network pay 20% of cost

5. 8. Surgery for foot (out of network) – Cost $5400

5.1. Out of network pay 20% of cost

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

6.1. pay $5

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

7.1. Out of Network pay 20% of cost

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

8.1. Pay $25

9. 1. Doctor’s office visit for cough (in network) - Cost $95

9.1. In network pay $5

10. 2. Emergency room visit for stitches - cost $1,152

10.1. Pay $25

11. 3. Hospital stay for flu (out of network) – Cost $1,500

11.1. Out of Network pay 20% of cost