Heights University Hospital

All Charges

Charge

Type

Setting

Price

IV INF TOCILIZUM COVID19 DOSE2

Facility

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	4229M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	4201M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3120M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	4229M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3247M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3043M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3080M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3050M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3190M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3082M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3234M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3049M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3247M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3235M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3246M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3048M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3234M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3037M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3080M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3024M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3037M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3042M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3230M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3042M0250
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

$2,250.00

Service Code	HCPCS M0250
Hospital Charge Code	3235M0250
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

Know your out-of-pocket cost for care.

All Charges