Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSN REV CCK VE 12MM L 11-13 GH

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270695149
Hospital Revenue Code	278
Min. Negotiated Rate	$436.81
Max. Negotiated Rate	$9,062.50
Rate for Payer: Aetna Commercial	$6,887.50
Rate for Payer: Aetna Medicare Advantage	$5,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,621.88
Rate for Payer: Cigna Commercial	$9,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75
Rate for Payer: UnitedHealthcare Community & State	$436.81
Rate for Payer: Wellpoint Medicaid Managed Care	$480.31

PSN REV FEM CMT CCR PLS SZ3

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270694073
Hospital Revenue Code	278
Min. Negotiated Rate	$8,292.19
Max. Negotiated Rate	$13,378.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,161.88
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19

PSN REV FEM CMT CCR PLS SZ3

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270694073
Hospital Revenue Code	278
Min. Negotiated Rate	$1,332.28
Max. Negotiated Rate	$27,640.62
Rate for Payer: Aetna Commercial	$21,006.88
Rate for Payer: Aetna Medicare Advantage	$16,584.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,096.72
Rate for Payer: Cigna Commercial	$27,640.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,161.88
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19
Rate for Payer: UnitedHealthcare Community & State	$1,332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1,464.95

PSN REV FEM CMT CCR PLS SZ 3L

Facility

$727.20

Service Code	HCPCS C1776
Hospital Charge Code	270699862
Hospital Revenue Code	278
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna Commercial	$276.34
Rate for Payer: Aetna Medicare Advantage	$218.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.44
Rate for Payer: Cigna Commercial	$363.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.98
Rate for Payer: Qualcare PPO/HMO/WC	$109.08
Rate for Payer: UnitedHealthcare Community & State	$17.53
Rate for Payer: Wellpoint Medicaid Managed Care	$19.27

PSN REV FEM CMT CCR PLS SZ 3L

Facility

$727.20

Service Code	HCPCS C1776
Hospital Charge Code	270699862
Hospital Revenue Code	278
Min. Negotiated Rate	$109.08
Max. Negotiated Rate	$175.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.98
Rate for Payer: Qualcare PPO/HMO/WC	$109.08

PSN REV FEM CMT CCR PLS SZ7 L

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270691596
Hospital Revenue Code	278
Min. Negotiated Rate	$8,292.19
Max. Negotiated Rate	$13,378.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,161.88
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19

PSN REV FEM CMT CCR PLS SZ7 L

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270691596
Hospital Revenue Code	278
Min. Negotiated Rate	$1,332.28
Max. Negotiated Rate	$27,640.62
Rate for Payer: Aetna Commercial	$21,006.88
Rate for Payer: Aetna Medicare Advantage	$16,584.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,096.72
Rate for Payer: Cigna Commercial	$27,640.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,161.88
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19
Rate for Payer: UnitedHealthcare Community & State	$1,332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1,464.95

PSN REV FEM CMT CCR PL SZ 7 R

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270694282
Hospital Revenue Code	278
Min. Negotiated Rate	$8,292.19
Max. Negotiated Rate	$13,378.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,161.88
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19

PSN REV FEM CMT CCR PL SZ 7 R

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270694282
Hospital Revenue Code	278
Min. Negotiated Rate	$1,332.28
Max. Negotiated Rate	$27,640.62
Rate for Payer: Aetna Commercial	$21,006.88
Rate for Payer: Aetna Medicare Advantage	$16,584.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,096.72
Rate for Payer: Cigna Commercial	$27,640.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,161.88
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19
Rate for Payer: UnitedHealthcare Community & State	$1,332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1,464.95

PSN REV FEM CMT CCR STD SZ11 L

Facility

$51,656.25

Service Code	HCPCS C1776
Hospital Charge Code	270695148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,244.92
Max. Negotiated Rate	$25,828.12
Rate for Payer: Aetna Commercial	$19,629.38
Rate for Payer: Aetna Medicare Advantage	$15,496.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,172.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,172.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,172.34
Rate for Payer: Cigna Commercial	$25,828.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,500.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,364.38
Rate for Payer: Qualcare PPO/HMO/WC	$7,748.44
Rate for Payer: UnitedHealthcare Community & State	$1,244.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1,368.89

PSN REV FEM CMT CCR STD SZ11 L

Facility

$51,656.25

Service Code	HCPCS C1776
Hospital Charge Code	270695148
Hospital Revenue Code	278
Min. Negotiated Rate	$7,748.44
Max. Negotiated Rate	$12,500.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,331.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,500.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,364.38
Rate for Payer: Qualcare PPO/HMO/WC	$7,748.44

PSN REV FEM CMT CCR STD SZ 5

Facility

$44,040.00

Service Code	HCPCS C1776
Hospital Charge Code	270692736
Hospital Revenue Code	278
Min. Negotiated Rate	$1,061.36
Max. Negotiated Rate	$22,020.00
Rate for Payer: Aetna Commercial	$16,735.20
Rate for Payer: Aetna Medicare Advantage	$13,212.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,230.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,230.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,230.20
Rate for Payer: Cigna Commercial	$22,020.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,657.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,688.80
Rate for Payer: Qualcare PPO/HMO/WC	$6,606.00
Rate for Payer: UnitedHealthcare Community & State	$1,061.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1,167.06

PSN REV FEM CMT CCR STD SZ 5

Facility

$44,040.00

Service Code	HCPCS C1776
Hospital Charge Code	270692736
Hospital Revenue Code	278
Min. Negotiated Rate	$6,606.00
Max. Negotiated Rate	$10,657.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,808.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,657.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,688.80
Rate for Payer: Qualcare PPO/HMO/WC	$6,606.00

PSN REV FEM CMT CCR STD SZ 5 L

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270696798
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR STD SZ 5 L

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270696798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.48
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,282.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1,410.20

PSN REV FEM CMT CCR STD SZ7 LT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697666
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR STD SZ7 LT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.48
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,282.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1,410.20

PSN REV FEM CMT CCR STD SZ 9 L

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270690145
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.48
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,282.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1,410.20

PSN REV FEM CMT CCR STD SZ 9 L

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270690145
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR STD SZ9 LT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697462
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR STD SZ9 LT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697462
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.48
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,282.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1,410.20

PSN REV FEM CMT CCR SZ 7

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270698591
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR SZ 7

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270698591
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.48
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,282.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1,410.20

PSN REV FEM DISTAL AUG SZ 5

Facility

$6,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270692737
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.50
Max. Negotiated Rate	$1,648.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,498.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.50

PSN REV FEM DISTAL AUG SZ 5

Facility

$6,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270692737
Hospital Revenue Code	278
Min. Negotiated Rate	$164.12
Max. Negotiated Rate	$3,405.00
Rate for Payer: Aetna Commercial	$2,587.80
Rate for Payer: Aetna Medicare Advantage	$2,043.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,736.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,736.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,736.55
Rate for Payer: Cigna Commercial	$3,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,498.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.50
Rate for Payer: UnitedHealthcare Community & State	$164.12
Rate for Payer: Wellpoint Medicaid Managed Care	$180.47

Know your out-of-pocket cost for care.

All Charges