Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FIBRINOGEN

Facility

$118.00

Service Code	HCPCS 85384
Hospital Charge Code	38478014
Hospital Revenue Code	305
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

FIBRINOGEN

Facility

$58.40

Service Code	HCPCS 85384
Hospital Charge Code	39900171
Hospital Revenue Code	305
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.44
Rate for Payer: Aetna Medicare Advantage	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.09
Rate for Payer: Cigna Commercial	$29.20
Rate for Payer: Cigna Medicare Advantage	$9.72
Rate for Payer: Clover Medicare Advantage	$9.23
Rate for Payer: EmblemHealth Commercial	$29.16
Rate for Payer: Humana Medicare Advantage	$10.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.76
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72
Rate for Payer: Wellcare Medicare Advantage	$9.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

FIBRINOGEN DEGRADATION PRODUCT

Facility

$105.18

Service Code	HCPCS 85362
Hospital Charge Code	38478020
Hospital Revenue Code	305
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare Advantage	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.87
Rate for Payer: Cigna Commercial	$52.59
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Medicare Advantage	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$2.79

FIBRINOGEN DEGRADATION PRODUCT

Facility

$105.18

Service Code	HCPCS 85362
Hospital Charge Code	38478020
Hospital Revenue Code	305
Min. Negotiated Rate	$15.78
Max. Negotiated Rate	$15.78
Rate for Payer: Qualcare PPO/HMO/WC	$15.78

FIBRINOGEN IGA AGGREGATE

Facility

$844.00

Service Code	HCPCS 85366
Hospital Charge Code	3008893
Hospital Revenue Code	305
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$422.00
Rate for Payer: Aetna Commercial	$218.85
Rate for Payer: Aetna Medicare Advantage	$260.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$80.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.44
Rate for Payer: Cigna Commercial	$422.00
Rate for Payer: Cigna Medicare Advantage	$80.46
Rate for Payer: Clover Medicare Advantage	$76.44
Rate for Payer: EmblemHealth Commercial	$241.38
Rate for Payer: Humana Medicare Advantage	$82.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$80.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$64.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.46
Rate for Payer: Wellcare Medicare Advantage	$80.46
Rate for Payer: Wellpoint Medicaid Managed Care	$22.37

FIBRINOGEN IGA AGGREGATE

Facility

$844.00

Service Code	HCPCS 85366
Hospital Charge Code	3008893
Hospital Revenue Code	305
Min. Negotiated Rate	$126.60
Max. Negotiated Rate	$126.60
Rate for Payer: Qualcare PPO/HMO/WC	$126.60

FIBRINOGEN, QUANT

Facility

$667.59

Service Code	HCPCS 85384
Hospital Charge Code	3001302
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

FIBRINOGEN, QUANT

Facility

$667.59

Service Code	HCPCS 85384
Hospital Charge Code	3001302
Hospital Revenue Code	305
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$26.44
Rate for Payer: Aetna Medicare Advantage	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.09
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$9.72
Rate for Payer: Clover Medicare Advantage	$9.23
Rate for Payer: EmblemHealth Commercial	$29.16
Rate for Payer: Humana Medicare Advantage	$10.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72
Rate for Payer: Wellcare Medicare Advantage	$9.72
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

FIBRINOLYS/DNA-ASE OINT 28GM

Facility

$11.25

Hospital Charge Code	6002398
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

FIBRINOLYS/DNA-ASE OINT 28GM

Facility

$11.25

Hospital Charge Code	6002398
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

FIBRINOLYSIN 30U/CLORCL 300MG

Facility

$352.65

Hospital Charge Code	6009419
Hospital Revenue Code	250
Min. Negotiated Rate	$52.90
Max. Negotiated Rate	$52.90
Rate for Payer: Qualcare PPO/HMO/WC	$52.90

FIBRINOLYSIN 30U/CLORCL 300MG

Facility

$352.65

Hospital Charge Code	6009419
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$176.32
Rate for Payer: Aetna Commercial	$134.01
Rate for Payer: Aetna Medicare Advantage	$105.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.93
Rate for Payer: Cigna Commercial	$176.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.80
Rate for Payer: Oxford Commercial	$70.53
Rate for Payer: Qualcare PPO/HMO/WC	$52.90
Rate for Payer: UnitedHealthcare Commercial	$70.53
Rate for Payer: UnitedHealthcare Community & State	$8.50
Rate for Payer: Wellpoint Medicaid Managed Care	$9.35

FIBRINOLYTIC FACTRS/INHIB PLAS

Facility

$121.75

Service Code	HCPCS 85415
Hospital Charge Code	38477145
Hospital Revenue Code	305
Min. Negotiated Rate	$18.26
Max. Negotiated Rate	$18.26
Rate for Payer: Qualcare PPO/HMO/WC	$18.26

FIBRINOLYTIC FACTRS/INHIB PLAS

Facility

$121.75

Service Code	HCPCS 85415
Hospital Charge Code	38477145
Hospital Revenue Code	305
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.76
Rate for Payer: Aetna Medicare Advantage	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.05
Rate for Payer: Cigna Commercial	$60.88
Rate for Payer: Cigna Medicare Advantage	$17.19
Rate for Payer: Clover Medicare Advantage	$16.33
Rate for Payer: EmblemHealth Commercial	$51.57
Rate for Payer: Humana Medicare Advantage	$17.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.26
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.19
Rate for Payer: Wellcare Medicare Advantage	$17.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

FIBRINOLYTIC PLASMINOGEN

Facility

$390.00

Service Code	HCPCS 85420
Hospital Charge Code	401485420
Hospital Revenue Code	305
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$17.76
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Medicare Advantage	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FIBRINOLYTIC PLASMINOGEN

Facility

$390.00

Service Code	HCPCS 85420
Hospital Charge Code	401485420
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FIBRIN SPLIT PRODUCTS

Facility

$390.00

Service Code	HCPCS 85362
Hospital Charge Code	3002946
Hospital Revenue Code	305
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare Advantage	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.87
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Medicare Advantage	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FIBRIN SPLIT PRODUCTS

Facility

$390.00

Service Code	HCPCS 85362
Hospital Charge Code	3002946
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FIBROGEN ACTIVITY

Facility

$390.00

Service Code	HCPCS 85384
Hospital Charge Code	401485384
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FIBROGEN ACTIVITY

Facility

$390.00

Service Code	HCPCS 85384
Hospital Charge Code	401485384
Hospital Revenue Code	305
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$26.44
Rate for Payer: Aetna Medicare Advantage	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.09
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.72
Rate for Payer: Clover Medicare Advantage	$9.23
Rate for Payer: EmblemHealth Commercial	$29.16
Rate for Payer: Humana Medicare Advantage	$10.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72
Rate for Payer: Wellcare Medicare Advantage	$9.72
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FIBULA ANATOMIC LOCK RIGHT 4H

Facility

$3,172.00

Service Code	HCPCS C1713
Hospital Charge Code	270681981
Hospital Revenue Code	278
Min. Negotiated Rate	$76.45
Max. Negotiated Rate	$1,586.00
Rate for Payer: Aetna Commercial	$1,205.36
Rate for Payer: Aetna Medicare Advantage	$951.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$808.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$808.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$634.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$808.86
Rate for Payer: Cigna Commercial	$1,586.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$767.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$697.84
Rate for Payer: Qualcare PPO/HMO/WC	$475.80
Rate for Payer: UnitedHealthcare Community & State	$76.45
Rate for Payer: Wellpoint Medicaid Managed Care	$84.06

FIBULA ANATOMIC LOCK RIGHT 4H

Facility

$3,172.00

Service Code	HCPCS C1713
Hospital Charge Code	270681981
Hospital Revenue Code	278
Min. Negotiated Rate	$475.80
Max. Negotiated Rate	$767.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$634.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$767.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$697.84
Rate for Payer: Qualcare PPO/HMO/WC	$475.80

FIBULA COMP LOCK PLATE 10H

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270685141
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

FIBULA COMP LOCK PLATE 10H

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270685141
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

FIBULA PLATE 1

Facility

$4,088.25

Hospital Charge Code	270656679
Hospital Revenue Code	278
Min. Negotiated Rate	$98.53
Max. Negotiated Rate	$2,044.12
Rate for Payer: Aetna Commercial	$1,553.54
Rate for Payer: Aetna Medicare Advantage	$1,226.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$817.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,042.50
Rate for Payer: Cigna Commercial	$2,044.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$899.41
Rate for Payer: Qualcare PPO/HMO/WC	$613.24
Rate for Payer: UnitedHealthcare Community & State	$98.53
Rate for Payer: Wellpoint Medicaid Managed Care	$108.34

Know your out-of-pocket cost for care.

All Charges