Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALLODERM 6 CM x12 CM

Facility

$13,535.00

Service Code	HCPCS Q4116
Hospital Charge Code	270681284
Hospital Revenue Code	278
Min. Negotiated Rate	$2,030.25
Max. Negotiated Rate	$3,275.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,707.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,275.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,977.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,030.25

ALLODERM CONTOUR LARGE 1MM TIC

Facility

$34,095.00

Service Code	HCPCS Q4116
Hospital Charge Code	270665261
Hospital Revenue Code	636
Min. Negotiated Rate	$5,114.25
Max. Negotiated Rate	$8,250.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25

ALLODERM CONTOUR LARGE 1MM TIC

Facility

$34,095.00

Service Code	HCPCS Q4116
Hospital Charge Code	270665261
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$8,250.99
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25
Rate for Payer: UnitedHealthcare Community & State	$821.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$903.52

ALLO-DERM CONTOUR MEDIUM

Facility

$27,005.00

Hospital Charge Code	270664494
Hospital Revenue Code	636
Min. Negotiated Rate	$650.82
Max. Negotiated Rate	$13,502.50
Rate for Payer: Aetna Commercial	$10,261.90
Rate for Payer: Aetna Medicare Advantage	$8,101.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,886.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,886.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,886.27
Rate for Payer: Cigna Commercial	$13,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,535.21
Rate for Payer: Qualcare PPO/HMO/WC	$4,050.75
Rate for Payer: UnitedHealthcare Community & State	$650.82
Rate for Payer: Wellpoint Medicaid Managed Care	$715.63

ALLO-DERM CONTOUR MEDIUM

Facility

$27,005.00

Hospital Charge Code	270664494
Hospital Revenue Code	636
Min. Negotiated Rate	$4,050.75
Max. Negotiated Rate	$6,535.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,535.21
Rate for Payer: Qualcare PPO/HMO/WC	$4,050.75

ALLODERM DERMAL GRAFT

Facility

$973.00

Hospital Charge Code	270335499
Hospital Revenue Code	636
Min. Negotiated Rate	$145.95
Max. Negotiated Rate	$235.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.47
Rate for Payer: Qualcare PPO/HMO/WC	$145.95

ALLODERM DERMAL GRAFT

Facility

$973.00

Hospital Charge Code	270335499
Hospital Revenue Code	636
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$486.50
Rate for Payer: Aetna Commercial	$369.74
Rate for Payer: Aetna Medicare Advantage	$291.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.12
Rate for Payer: Cigna Commercial	$486.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.47
Rate for Payer: Qualcare PPO/HMO/WC	$145.95
Rate for Payer: UnitedHealthcare Community & State	$23.45
Rate for Payer: Wellpoint Medicaid Managed Care	$25.78

ALLODERM GRAFT 8X16CM

Facility

$24,450.00

Hospital Charge Code	270339540
Hospital Revenue Code	636
Min. Negotiated Rate	$589.25
Max. Negotiated Rate	$12,225.00
Rate for Payer: Aetna Commercial	$9,291.00
Rate for Payer: Aetna Medicare Advantage	$7,335.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,234.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,234.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,234.75
Rate for Payer: Cigna Commercial	$12,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,916.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,667.50
Rate for Payer: UnitedHealthcare Community & State	$589.25
Rate for Payer: Wellpoint Medicaid Managed Care	$647.92

ALLODERM GRAFT 8X16CM

Facility

$24,450.00

Hospital Charge Code	270339540
Hospital Revenue Code	636
Min. Negotiated Rate	$3,667.50
Max. Negotiated Rate	$5,916.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,916.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,667.50

ALLODERM GRAFT 8X16CM/SQ CM JW

Facility

$191.02

Hospital Charge Code	270339540W
Hospital Revenue Code	636
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$46.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.23
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

ALLODERM GRAFT 8X16CM/SQ CM JW

Facility

$191.02

Hospital Charge Code	270339540W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$95.51
Rate for Payer: Aetna Commercial	$72.59
Rate for Payer: Aetna Medicare Advantage	$57.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.71
Rate for Payer: Cigna Commercial	$95.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.23
Rate for Payer: Qualcare PPO/HMO/WC	$28.65
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

ALLODERM MEDIUM 12X20CM

Facility

$50,805.00

Service Code	HCPCS Q4116
Hospital Charge Code	270695703
Hospital Revenue Code	278
Min. Negotiated Rate	$7,620.75
Max. Negotiated Rate	$12,294.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,161.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,294.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,177.10
Rate for Payer: Qualcare PPO/HMO/WC	$7,620.75

ALLODERM MEDIUM 12X20CM

Facility

$50,805.00

Service Code	HCPCS Q4116
Hospital Charge Code	270695703
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$12,294.81
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,161.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,294.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,177.10
Rate for Payer: Qualcare PPO/HMO/WC	$7,620.75
Rate for Payer: UnitedHealthcare Community & State	$1,224.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,346.33

ALLO DERM REGENERATIVE TISSUE

Facility

$13,755.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678871
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.25
Max. Negotiated Rate	$3,328.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,328.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,026.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.25

ALLO DERM REGENERATIVE TISSUE

Facility

$13,755.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678871
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,328.71
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,328.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,026.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.25
Rate for Payer: UnitedHealthcare Community & State	$331.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$364.51

ALLO DERM REGEN TISSUE 4X12CMC

Facility

$9,025.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678873
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$2,184.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,985.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

ALLO DERM REGEN TISSUE 4X12CMC

Facility

$9,025.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678873
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,184.05
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,985.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75
Rate for Payer: UnitedHealthcare Community & State	$217.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$239.16

ALLO DERM REGEN TISSUE 4X7 CMC

Facility

$1,865.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678168
Hospital Revenue Code	278
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$533.66
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$410.30
Rate for Payer: Qualcare PPO/HMO/WC	$279.75
Rate for Payer: UnitedHealthcare Community & State	$44.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$49.42

ALLO DERM REGEN TISSUE 4X7 CMC

Facility

$1,865.00

Service Code	HCPCS Q4116
Hospital Charge Code	270678168
Hospital Revenue Code	278
Min. Negotiated Rate	$279.75
Max. Negotiated Rate	$451.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$410.30
Rate for Payer: Qualcare PPO/HMO/WC	$279.75

ALLODERM REG TISSUE MATRIX

Facility

$485.00

Service Code	HCPCS Q4116
Hospital Charge Code	270679527
Hospital Revenue Code	636
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$117.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

ALLODERM REG TISSUE MATRIX

Facility

$485.00

Service Code	HCPCS Q4116
Hospital Charge Code	270679527
Hospital Revenue Code	636
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$533.66
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: Qualcare PPO/HMO/WC	$72.75
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

ALLODERM TISSUE MARIX 8X12CM

Facility

$19,080.00

Service Code	HCPCS Q4116
Hospital Charge Code	270681885
Hospital Revenue Code	278
Min. Negotiated Rate	$2,862.00
Max. Negotiated Rate	$4,617.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,816.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,617.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,197.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,862.00

ALLODERM TISSUE MARIX 8X12CM

Facility

$19,080.00

Service Code	HCPCS Q4116
Hospital Charge Code	270681885
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,617.36
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,617.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,197.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,862.00
Rate for Payer: UnitedHealthcare Community & State	$459.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$505.62

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$390,572.46

Service Code	MSDRG 014
Min. Negotiated Rate	$118,924.31
Max. Negotiated Rate	$390,572.46
Rate for Payer: Aetna Medicare Advantage	$390,572.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266,571.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266,571.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$125,183.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266,571.06
Rate for Payer: Cigna Commercial	$224,902.98
Rate for Payer: Cigna Medicare Advantage	$125,183.48
Rate for Payer: Clover Medicare Advantage	$118,924.31
Rate for Payer: EmblemHealth Commercial	$375,550.44
Rate for Payer: Humana Medicare Advantage	$128,938.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$125,183.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$125,183.48
Rate for Payer: Wellcare Medicare Advantage	$125,183.48

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$109,613.16

Service Code	APR-DRG 0073
Min. Negotiated Rate	$107,463.88
Max. Negotiated Rate	$109,613.16
Rate for Payer: UnitedHealthcare Community & State	$107,463.88
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$109,613.16
Rate for Payer: Wellpoint Medicaid Managed Care	$107,463.88

Know your out-of-pocket cost for care.

All Charges