Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIATH FEM STEM CMNT 12X100MM

Facility

$8,274.50

Service Code	HCPCS C1776
Hospital Charge Code	270697480
Hospital Revenue Code	278
Min. Negotiated Rate	$199.42
Max. Negotiated Rate	$4,137.25
Rate for Payer: Aetna Commercial	$3,144.31
Rate for Payer: Aetna Medicare Advantage	$2,482.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,654.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,110.00
Rate for Payer: Cigna Commercial	$4,137.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,002.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,820.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,241.17
Rate for Payer: UnitedHealthcare Community & State	$199.42
Rate for Payer: Wellpoint Medicaid Managed Care	$219.27

TRIATHL CRUC RET FEM RTSZ2-CAP

Facility

$7,765.80

Service Code	HCPCS C1776
Hospital Charge Code	270692889
Hospital Revenue Code	278
Min. Negotiated Rate	$187.16
Max. Negotiated Rate	$3,882.90
Rate for Payer: Aetna Commercial	$2,951.00
Rate for Payer: Aetna Medicare Advantage	$2,329.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,980.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,980.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,553.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,980.28
Rate for Payer: Cigna Commercial	$3,882.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,879.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,708.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.87
Rate for Payer: UnitedHealthcare Community & State	$187.16
Rate for Payer: Wellpoint Medicaid Managed Care	$205.79

TRIATHL CRUC RET FEM RTSZ2-CAP

Facility

$7,765.80

Service Code	HCPCS C1776
Hospital Charge Code	270692889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.87
Max. Negotiated Rate	$1,879.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,553.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,879.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,708.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.87

TRIATHLON BASEPLATE SIZE 7

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270692856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.65
Max. Negotiated Rate	$1,654.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,504.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65

TRIATHLON BASEPLATE SIZE 7

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270692856
Hospital Revenue Code	278
Min. Negotiated Rate	$164.79
Max. Negotiated Rate	$3,418.85
Rate for Payer: Aetna Commercial	$2,598.33
Rate for Payer: Aetna Medicare Advantage	$2,051.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.61
Rate for Payer: Cigna Commercial	$3,418.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,504.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65
Rate for Payer: UnitedHealthcare Community & State	$164.79
Rate for Payer: Wellpoint Medicaid Managed Care	$181.20

TRIATHLON CR FEM COMP LT SZ6

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692854
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

TRIATHLON CR FEM COMP LT SZ6

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692854
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CR FEM COMPONENT 3L

Facility

$10,529.05

Service Code	HCPCS C1776
Hospital Charge Code	270692079
Hospital Revenue Code	278
Min. Negotiated Rate	$253.75
Max. Negotiated Rate	$5,264.52
Rate for Payer: Aetna Commercial	$4,001.04
Rate for Payer: Aetna Medicare Advantage	$3,158.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,684.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,684.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,684.91
Rate for Payer: Cigna Commercial	$5,264.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.36
Rate for Payer: UnitedHealthcare Community & State	$253.75
Rate for Payer: Wellpoint Medicaid Managed Care	$279.02

TRIATHLON CR FEM COMPONENT 3L

Facility

$10,529.05

Service Code	HCPCS C1776
Hospital Charge Code	270692079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.36
Max. Negotiated Rate	$2,548.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.36

TRIATHLON CRF SZ 4 SDE LFT T

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270692360
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.75
Rate for Payer: Aetna Commercial	$4,001.21
Rate for Payer: Aetna Medicare Advantage	$3,158.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.02
Rate for Payer: Cigna Commercial	$5,264.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

TRIATHLON CRF SZ 4 SDE LFT T

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270692360
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLONCRF SZE #4 LT TYP CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLONCRF SZE #4 LT TYP CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691185
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

TRIATHLON CRUCIATE RETAIN FEM

Facility

$11,762.20

Service Code	HCPCS C1713
Hospital Charge Code	270704901
Hospital Revenue Code	278
Min. Negotiated Rate	$283.47
Max. Negotiated Rate	$5,881.10
Rate for Payer: Aetna Commercial	$4,469.64
Rate for Payer: Aetna Medicare Advantage	$3,528.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,999.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,999.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,352.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,999.36
Rate for Payer: Cigna Commercial	$5,881.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,846.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,587.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,764.33
Rate for Payer: UnitedHealthcare Community & State	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$311.70

TRIATHLON CRUCIATE RETAIN FEM

Facility

$11,762.20

Service Code	HCPCS C1713
Hospital Charge Code	270704901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,764.33
Max. Negotiated Rate	$2,846.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,352.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,846.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,587.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,764.33

TRIATHLON CRUC RET FEM SZ6 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692910
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON CRUC RET FEM SZ6 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270692910
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

TRIATHLON CRUC RET FEM SZ7 RT

Facility

$8,844.75

Service Code	HCPCS C1776
Hospital Charge Code	270693063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.71
Max. Negotiated Rate	$2,140.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,140.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,945.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.71

TRIATHLON CRUC RET FEM SZ7 RT

Facility

$8,844.75

Service Code	HCPCS C1776
Hospital Charge Code	270693063
Hospital Revenue Code	278
Min. Negotiated Rate	$213.16
Max. Negotiated Rate	$4,422.38
Rate for Payer: Aetna Commercial	$3,361.01
Rate for Payer: Aetna Medicare Advantage	$2,653.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,255.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,255.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,255.41
Rate for Payer: Cigna Commercial	$4,422.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,140.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,945.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.71
Rate for Payer: UnitedHealthcare Community & State	$213.16
Rate for Payer: Wellpoint Medicaid Managed Care	$234.39

TRIATHLON CRU RET FEM CR SZ5LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691178
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

TRIATHLON CRU RET FEM CR SZ5LT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270691178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATHLON FEMORAL CR SZ3

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270697037
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$3,618.82
Rate for Payer: Aetna Commercial	$2,750.31
Rate for Payer: Aetna Medicare Advantage	$2,171.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.60
Rate for Payer: Cigna Commercial	$3,618.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65
Rate for Payer: UnitedHealthcare Community & State	$174.43
Rate for Payer: Wellpoint Medicaid Managed Care	$191.80

TRIATHLON FEMORAL CR SZ3

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270697037
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.65
Max. Negotiated Rate	$1,751.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65

TRIATHLON FEM STAB PS SZ4 LT

Facility

$7,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270691263
Hospital Revenue Code	278
Min. Negotiated Rate	$182.32
Max. Negotiated Rate	$3,782.50
Rate for Payer: Aetna Commercial	$2,874.70
Rate for Payer: Aetna Medicare Advantage	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,929.08
Rate for Payer: Cigna Commercial	$3,782.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,664.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75
Rate for Payer: UnitedHealthcare Community & State	$182.32
Rate for Payer: Wellpoint Medicaid Managed Care	$200.47

TRIATHLON FEM STAB PS SZ4 LT

Facility

$7,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270691263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.75
Max. Negotiated Rate	$1,830.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,664.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75

Know your out-of-pocket cost for care.

All Charges