Heights University Hospital

All Charges

Charge

Type

Setting

Price

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30420031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30460031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	32400031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	42010031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	42010031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30480031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	32370031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30200031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30470031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30430031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	31900031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30420031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	32470031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	39200031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	45020031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	31350031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	42290031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	36520031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30330031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	48180031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30240031A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	32460031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30240031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30370031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

JANSSEN COVID19 VACC ADM DOSE

Facility

$50.00

Service Code	HCPCS 0031A
Hospital Charge Code	30490031A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

Know your out-of-pocket cost for care.

All Charges