Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BAMLANIVIMAB 700MG EUA ONLY

Facility

$0.01

Service Code	HCPCS Q0239
Hospital Charge Code	606390382
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BAMLANIVIMAB 700MG EUA ONLY

Facility

$0.01

Service Code	HCPCS Q0239
Hospital Charge Code	606390382
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3248M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3037M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3230M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3082M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	4201M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3033M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3047M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3121M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	4201M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3246M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3190M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3234M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3043M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	4229M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3240M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3121M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	4229M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3050M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3046M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3190M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3230M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3080M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3050M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

Know your out-of-pocket cost for care.

All Charges