Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

IV INF TOCILIZUM COVID19 DOSE2

Facility

IP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3246M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INF TOCILIZUM COVID19 DOSE2

Facility

IP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3033M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INF TOCILIZUM COVID19 DOSE2

Facility

IP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3050M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INF TOCILIZUM COVID19 DOSE2

Facility

OP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3033M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

IV INF TOCILIZUM COVID19 DOSE2

Facility

IP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3240M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INF TOCILIZUM COVID19 DOSE2

Facility

OP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3190M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

IV INF TOCILIZUM COVID19 DOSE2

Facility

IP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3121M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INF TOCILIZUM COVID19 DOSE2

Facility

IP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3237M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INF TOCILIZUM COVID19 DOSE2

Facility

OP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3048M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

IV INF TOCILIZUM COVID19 DOSE2

Facility

IP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3043M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INF TOCILIZUM COVID19 DOSE2

Facility

OP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3240M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

IV INF TOCILIZUM COVID19 DOSE2

Facility

OP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3237M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

IV INF TOCILIZUM COVID19 DOSE2

Facility

OP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3047M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

IV INF TOCILIZUM COVID19 DOSE2

Facility

IP

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3248M0250
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INFUS 16-90 EA ADD VAS

Facility

IP

$1,405.77

Service Code	HCPCS 9636559
Hospital Charge Code	93500035
Hospital Revenue Code	260
Min. Negotiated Rate	$210.87
Max. Negotiated Rate	$210.87
Rate for Payer: Qualcare PPO/HMO/WC	$210.87

IV INFUS 16-90 EA ADD VAS

Facility

OP

$1,405.77

Service Code	HCPCS 9636559
Hospital Charge Code	93500035
Hospital Revenue Code	260
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$421.73
Rate for Payer: Aetna Medicare Advantage	$421.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.47
Rate for Payer: Cigna Commercial	$702.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.75
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.87
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV INFUSION

Facility

OP

$297.60

Service Code	HCPCS 90780
Hospital Charge Code	1001105
Hospital Revenue Code	260
Min. Negotiated Rate	$38.69
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$89.28
Rate for Payer: Aetna Medicare Advantage	$89.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.89
Rate for Payer: Cigna Commercial	$148.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.69
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.64
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV INFUSION

Facility

IP

$297.60

Service Code	HCPCS 90780
Hospital Charge Code	1001105
Hospital Revenue Code	260
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$44.64
Rate for Payer: Qualcare PPO/HMO/WC	$44.64

IV INFUSION IMMUNOGLOBULN

Facility

OP

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	93500031
Hospital Revenue Code	260
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$421.73
Rate for Payer: Aetna Medicare Advantage	$421.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.47
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.75
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.87
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV INFUSION IMMUNOGLOBULN

Facility

IP

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	93500031
Hospital Revenue Code	260
Min. Negotiated Rate	$210.87
Max. Negotiated Rate	$210.87
Rate for Payer: Qualcare PPO/HMO/WC	$210.87

IV INFUS MED 16-90-SUBSEQ

Facility

IP

$613.00

Service Code	HCPCS 96366
Hospital Charge Code	93500039
Hospital Revenue Code	260
Min. Negotiated Rate	$91.95
Max. Negotiated Rate	$91.95
Rate for Payer: Qualcare PPO/HMO/WC	$91.95

IV INFUS MED 16-90-SUBSEQ

Facility

OP

$613.00

Service Code	HCPCS 96366
Hospital Charge Code	93500039
Hospital Revenue Code	260
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$183.90
Rate for Payer: Aetna Medicare Advantage	$183.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.31
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.69
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.95
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV LINE PROTECTOR STRIP

Facility

OP

$347.63

Hospital Charge Code	270649665
Hospital Revenue Code	272
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$173.81
Rate for Payer: Aetna Commercial	$104.29
Rate for Payer: Aetna Medicare Advantage	$104.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.65
Rate for Payer: Cigna Commercial	$173.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.19
Rate for Payer: Oxford Commercial	$173.81
Rate for Payer: Qualcare PPO/HMO/WC	$52.14
Rate for Payer: UnitedHealthcare Commercial	$173.81

IV LINE PROTECTOR STRIP

Facility

IP

$347.63

Hospital Charge Code	270649665
Hospital Revenue Code	272
Min. Negotiated Rate	$52.14
Max. Negotiated Rate	$52.14
Rate for Payer: Qualcare PPO/HMO/WC	$52.14

IVP

Facility

IP

$1,255.00

Service Code	HCPCS 74400
Hospital Charge Code	94061149
Hospital Revenue Code	320
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$188.25
Rate for Payer: Qualcare PPO/HMO/WC	$188.25