Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3240M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$54.23
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	$675.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3043M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$37.31
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	$464.40
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$37.31
Rate for Payer: Wellpoint Medicaid Managed Care	$41.02

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3080M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3034M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$54.23
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	$675.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3082M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3050M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3042M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	4201M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$54.23
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	$675.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3235M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3048M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3049M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$37.31
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	$464.40
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$37.31
Rate for Payer: Wellpoint Medicaid Managed Care	$41.02

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3235M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$54.23
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	$675.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3024M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$54.23
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	$675.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3020M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3033M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3046M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3240M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3082M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$37.31
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	$464.40
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$37.31
Rate for Payer: Wellpoint Medicaid Managed Care	$41.02

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3190M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3034M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3043M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3048M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$37.31
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	$464.40
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$37.31
Rate for Payer: Wellpoint Medicaid Managed Care	$41.02

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3037M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$54.23
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	$675.00
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3047M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3247M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

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