Heights 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	$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

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3047M0222
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

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3046M0222
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

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	3120M0222
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

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	4201M0222
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

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3020M0222
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

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3235M0222
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

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3237M0222
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	3230M0222
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	3035M0222
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

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	4201M0222
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	3034M0222
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

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	3020M0222
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	$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

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	3050M0222
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

BEBTELOVIMAB INJ AND MONITOR

Facility

$2,250.00

Service Code	HCPCS M0222
Hospital Charge Code	3950M0222
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	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BECLOMETHASONE DIPRO INH

Facility

$64.00

Hospital Charge Code	6000558
Hospital Revenue Code	252
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

BECLOMETHASONE DIPRO INH

Facility

$64.00

Hospital Charge Code	6000558
Hospital Revenue Code	252
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

BECLOMETHASONE NSL 42MCG AQUE

Facility

$362.45

Hospital Charge Code	60628034
Hospital Revenue Code	250
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$181.22
Rate for Payer: Aetna Commercial	$108.73
Rate for Payer: Aetna Medicare Advantage	$108.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.42
Rate for Payer: Cigna Commercial	$181.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.12
Rate for Payer: Oxford Commercial	$181.22
Rate for Payer: Qualcare PPO/HMO/WC	$54.37
Rate for Payer: UnitedHealthcare Commercial	$181.22

BECLOMETHASONE NSL 42MCG AQUE

Facility

$362.45

Hospital Charge Code	60628034
Hospital Revenue Code	250
Min. Negotiated Rate	$54.37
Max. Negotiated Rate	$54.37
Rate for Payer: Qualcare PPO/HMO/WC	$54.37

Know your out-of-pocket cost for care.

All Charges