Health Plan Costs - Dylan Venter

1. 7. Urgent care visit for broken foot  Out Network  171$

2. 8. Surgery for foot  Out Network 1080$

3. 9. Prescription (generic)  In/Out Network (doesn't apply) 5$

4. 10. Doctor’s visit for annual physical  Out Network 191.60$

5. 11. Emergency room visit for snow board accident  In/Out Network (doesn't apply) 25$

6. 12. Urgent care visit for shots  In Network 10$

7. 1. 1. Doctor’s office visit for cough  In Network 5$

8. 2. 2. Emergency room visit for stitches  In/Out Network (doesn't apply) 25$

9. 3. 3. Hospital stay for flu  Out Network 300$

10. 4.  Appendectomy surgery In Network 0$

11. 5. Prescription (brand)  In/Out Network (doesn't apply) 10$

12. 6. Eye exam  Out Network 90.80$