Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3230M0245
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	3235M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$1,125.00
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: Cigna Commercial	$1,125.00
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

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

OP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3234M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$464.40
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	$201.24
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$103.00

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	3037M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$1,125.00
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: Cigna Commercial	$1,125.00
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

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

OP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3048M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$464.40
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	$201.24
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$103.00

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

IP

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3237M0245
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	3190M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$464.40
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	$201.24
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$103.00

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

OP

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3049M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$464.40
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	$201.24
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$103.00

BAMLANIVIMAB 700MG EUA ONLY

Facility

IP

$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 700MG EUA ONLY

Facility

OP

$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

BAMLANIVIMAB INFUS & MONITOR

Facility

IP

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3048M0239
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

OP

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3037M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$464.40
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	$201.24
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$103.00

BAMLANIVIMAB INFUS & MONITOR

Facility

IP

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3082M0239
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

IP

$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

IP

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3246M0239
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

IP

$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

IP

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3120M0239
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

IP

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3049M0239
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

OP

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3121M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$464.40
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	$201.24
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$103.00

BAMLANIVIMAB INFUS & MONITOR

Facility

OP

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3120M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$464.40
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	$201.24
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$103.00

<<
<
497
498
499
500
501
502
503
504
505
506
>
>>