Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3121M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3033M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3246M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
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: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3037M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3047M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
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: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3050M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
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: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3248M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
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: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3049M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	4229M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	4229M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
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: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3035M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
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: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3034M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3240M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3082M0222
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
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: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BEDSIDE PROCEDURE

Facility

$4,950.47

Hospital Charge Code	100033
Hospital Revenue Code	361
Min. Negotiated Rate	$140.59
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,881.18
Rate for Payer: Aetna Medicare Advantage	$1,485.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.37
Rate for Payer: Cigna Commercial	$2,475.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,287.12
Rate for Payer: Qualcare PPO/HMO/WC	$742.57
Rate for Payer: UnitedHealthcare Community & State	$156.43
Rate for Payer: Wellpoint Medicaid Managed Care	$140.59

BEDSIDE PROCEDURE

Facility

$4,950.47

Hospital Charge Code	100033
Hospital Revenue Code	361
Min. Negotiated Rate	$742.57
Max. Negotiated Rate	$742.57
Rate for Payer: Qualcare PPO/HMO/WC	$742.57

BEHAV CHNG SMOKING > 10 MIN

Facility

$2,700.00

Service Code	HCPCS 99407
Hospital Charge Code	412399407
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BEHAV CHNG SMOKING > 10 MIN

Facility

$2,700.00

Service Code	HCPCS 99407
Hospital Charge Code	395099407
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BEHAV CHNG SMOKING > 10 MIN

Facility

$2,700.00

Service Code	HCPCS 99407
Hospital Charge Code	395099407
Hospital Revenue Code	942
Min. Negotiated Rate	$42.28
Max. Negotiated Rate	$1,203.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.46
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

BEHAV CHNG SMOKING > 10 MIN

Facility

$2,700.00

Service Code	HCPCS 99407
Hospital Charge Code	412399407
Hospital Revenue Code	942
Min. Negotiated Rate	$42.28
Max. Negotiated Rate	$1,203.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.46
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

BEHAV CHNG SMOKING 3-10 MIN

Facility

$2,700.00

Service Code	HCPCS 99406
Hospital Charge Code	395099406
Hospital Revenue Code	942
Min. Negotiated Rate	$42.28
Max. Negotiated Rate	$1,203.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.46
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

BEHAV CHNG SMOKING 3-10 MIN

Facility

$2,700.00

Service Code	HCPCS 99406
Hospital Charge Code	395099406
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BEHAV CHNG SMOKING 3-10 MIN

Facility

$2,700.00

Service Code	HCPCS 99406
Hospital Charge Code	412399406
Hospital Revenue Code	942
Min. Negotiated Rate	$42.28
Max. Negotiated Rate	$1,203.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.46
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

BEHAV CHNG SMOKING 3-10 MIN

Facility

$2,700.00

Service Code	HCPCS 99406
Hospital Charge Code	412399406
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$85,030.76

Service Code	MSDRG 886
Min. Negotiated Rate	$7,161.00
Max. Negotiated Rate	$85,030.76
Rate for Payer: Aetna Commercial	$62,418.41
Rate for Payer: Aetna Medicare Advantage	$85,030.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,756.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,544.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,544.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,161.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,253.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,756.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,544.40
Rate for Payer: Cigna Commercial	$46,264.66
Rate for Payer: Cigna Medicare Advantage	$27,253.45
Rate for Payer: Clover Medicare Advantage	$25,890.78
Rate for Payer: EmblemHealth Commercial	$81,760.35
Rate for Payer: Humana Medicare Advantage	$28,071.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,253.45
Rate for Payer: Oxford Commercial	$36,566.79
Rate for Payer: UnitedHealthcare Commercial	$48,945.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,253.45
Rate for Payer: Wellcare Medicare Advantage	$27,253.45

Know your out-of-pocket cost for care.

All Charges