Heights University Hospital

All Charges

Charge

Type

Setting

Price

INFLUENZA TRIVALENT 0.5ML INJ

Facility

$36.00

Service Code	HCPCS 90658
Hospital Charge Code	60629256
Hospital Revenue Code	636
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

INFLUENZA TRIVALENT 0.5ML INJ

Facility

$36.00

Service Code	HCPCS 90658
Hospital Charge Code	60629256
Hospital Revenue Code	636
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$78.20
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$22.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

INFLUENZA TRIVALENT(A&B) 0.5ML

Facility

$59.97

Service Code	HCPCS 90656
Hospital Charge Code	60629317
Hospital Revenue Code	636
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$14.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

INFLUENZA TRIVALENT(A&B) 0.5ML

Facility

$59.97

Service Code	HCPCS 90656
Hospital Charge Code	60629317
Hospital Revenue Code	636
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$23.22
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare Advantage	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.29
Rate for Payer: Cigna Commercial	$23.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

INFLUENZA TYPE A/B RNA, RT-PCR

Facility

$479.00

Service Code	HCPCS 87502
Hospital Charge Code	401387502
Hospital Revenue Code	306
Min. Negotiated Rate	$47.90
Max. Negotiated Rate	$351.01
Rate for Payer: Aetna Commercial	$310.39
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.01
Rate for Payer: Cigna Commercial	$95.80
Rate for Payer: Cigna Medicare Advantage	$47.90
Rate for Payer: Clover Medicare Advantage	$91.01
Rate for Payer: EmblemHealth Commercial	$287.40
Rate for Payer: Humana Medicare Advantage	$98.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$101.55
Rate for Payer: Wellcare Medicare Advantage	$95.80

INFLUENZA TYPE A/B RNA, RT-PCR

Facility

$479.00

Service Code	HCPCS 87502
Hospital Charge Code	401387502
Hospital Revenue Code	306
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

INFLUENZA VACCINE 1994-1995

Facility

$13.00

Hospital Charge Code	6010524
Hospital Revenue Code	251
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

INFLUENZA VACCINE 1994-1995

Facility

$13.00

Hospital Charge Code	6010524
Hospital Revenue Code	251
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

INFLUENZA VA PRESERVAT FREE

Facility

$107.20

Service Code	HCPCS 90656
Hospital Charge Code	83652311
Hospital Revenue Code	636
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$32.16
Rate for Payer: Aetna Commercial	$32.16
Rate for Payer: Aetna Medicare Advantage	$32.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.34
Rate for Payer: Cigna Commercial	$23.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

INFLUENZA VA PRESERVAT FREE

Facility

$107.20

Service Code	HCPCS 90656
Hospital Charge Code	83652311
Hospital Revenue Code	636
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$25.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

INFLUENZA VC-NO PRE <3YR

Facility

$76.92

Service Code	HCPCS 90655
Hospital Charge Code	83652603
Hospital Revenue Code	636
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$38.46
Rate for Payer: Aetna Commercial	$23.08
Rate for Payer: Aetna Medicare Advantage	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.61
Rate for Payer: Cigna Commercial	$38.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54

INFLUENZA VC-NO PRE <3YR

Facility

$76.92

Service Code	HCPCS 90655
Hospital Charge Code	83652603
Hospital Revenue Code	636
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$18.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54

INFLUENZA VIRUS I

Facility

$114.00

Service Code	HCPCS 87804
Hospital Charge Code	3004315A
Hospital Revenue Code	306
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.62
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.64
Rate for Payer: Cigna Commercial	$16.55
Rate for Payer: Cigna Medicare Advantage	$8.28
Rate for Payer: Clover Medicare Advantage	$15.72
Rate for Payer: EmblemHealth Commercial	$49.65
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.54
Rate for Payer: Wellcare Medicare Advantage	$16.55

INFLUENZA VIRUS II

Facility

$114.00

Service Code	HCPCS 87804
Hospital Charge Code	3004315B
Hospital Revenue Code	306
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.62
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.64
Rate for Payer: Cigna Commercial	$16.55
Rate for Payer: Cigna Medicare Advantage	$8.28
Rate for Payer: Clover Medicare Advantage	$15.72
Rate for Payer: EmblemHealth Commercial	$49.65
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.54
Rate for Payer: Wellcare Medicare Advantage	$16.55

INFLUENZA VIRUS VACC 0.5ML INJ

Facility

$117.00

Service Code	HCPCS 90658
Hospital Charge Code	60629090
Hospital Revenue Code	636
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$28.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

INFLUENZA VIRUS VACC 0.5ML INJ

Facility

$117.00

Service Code	HCPCS 90658
Hospital Charge Code	60629090
Hospital Revenue Code	636
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$78.20
Rate for Payer: Aetna Commercial	$35.10
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$22.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

INFLUENZA VIRUS VACC/5ML

Facility

$99.36

Service Code	HCPCS Q2035
Hospital Charge Code	60634525
Hospital Revenue Code	636
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$49.68
Rate for Payer: Aetna Commercial	$29.81
Rate for Payer: Aetna Medicare Advantage	$29.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.34
Rate for Payer: Cigna Commercial	$49.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90

INFLUENZA VIRUS VACC/5ML

Facility

$99.36

Service Code	HCPCS Q2035
Hospital Charge Code	60634525
Hospital Revenue Code	636
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$24.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90

INFLUENZA VIRUS VACCINE

Facility

$44.00

Service Code	HCPCS 90658
Hospital Charge Code	60628904
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$78.20
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

INFLUENZA VIRUS VACCINE

Facility

$44.00

Service Code	HCPCS 90658
Hospital Charge Code	60628904
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$10.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

INFLUENZA VIRUS VACCINE****

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	60628305
Hospital Revenue Code	259
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

INFLUENZA VIRUS VACCINE****

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	60628305
Hospital Revenue Code	259
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

INFLUENZA VIRUS VACCINE INJ

Facility

$54.00

Hospital Charge Code	6003065
Hospital Revenue Code	636
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

INFLUENZA VIRUS VACCINE INJ

Facility

$54.00

Hospital Charge Code	6003065
Hospital Revenue Code	636
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$13.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

INFLUENZA VIRUS VACCINE-PEDS

Facility

$35.20

Service Code	HCPCS 90657
Hospital Charge Code	60628910
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$8.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.52
Rate for Payer: Qualcare PPO/HMO/WC	$5.28

Know your out-of-pocket cost for care.

All Charges