Heights University Hospital

All Charges

Charge

Type

Setting

Price

PET W CT ATTENU SK BS TO THIGH

Facility

$21,817.37

Service Code	HCPCS 78815
Hospital Charge Code	4501026
Hospital Revenue Code	404
Min. Negotiated Rate	$3,272.61
Max. Negotiated Rate	$3,272.61
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61

PET W CT ATTENU SK BS TO THIGH

Facility

$21,817.37

Service Code	HCPCS 78815
Hospital Charge Code	4501026
Hospital Revenue Code	404
Min. Negotiated Rate	$2,019.60
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$6,545.21
Rate for Payer: Aetna Medicare Advantage	$6,545.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,563.43
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.26
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET WHOLE BODY CA INIT

Facility

$21,817.37

Service Code	HCPCS 78816PI
Hospital Charge Code	4501027PI
Hospital Revenue Code	404
Min. Negotiated Rate	$3,272.61
Max. Negotiated Rate	$3,272.61
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61

PET WHOLE BODY CA INIT

Facility

$21,817.37

Service Code	HCPCS 78816PI
Hospital Charge Code	4501027PI
Hospital Revenue Code	404
Min. Negotiated Rate	$2,836.26
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$6,545.21
Rate for Payer: Aetna Medicare Advantage	$6,545.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,563.43
Rate for Payer: Cigna Commercial	$10,908.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.26
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET WHOLE BODY CA SUBS

Facility

$21,817.37

Service Code	HCPCS 78816PS
Hospital Charge Code	4501027PS
Hospital Revenue Code	404
Min. Negotiated Rate	$3,272.61
Max. Negotiated Rate	$3,272.61
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61

PET WHOLE BODY CA SUBS

Facility

$21,817.37

Service Code	HCPCS 78816PS
Hospital Charge Code	4501027PS
Hospital Revenue Code	404
Min. Negotiated Rate	$2,836.26
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$6,545.21
Rate for Payer: Aetna Medicare Advantage	$6,545.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,563.43
Rate for Payer: Cigna Commercial	$10,908.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.26
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PFI BIONTCOVID19VAC30MCG/0.3ML

Facility

$0.01

Service Code	HCPCS 91300
Hospital Charge Code	606390386
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

PFI BIONTCOVID19VAC30MCG/0.3ML

Facility

$0.01

Service Code	HCPCS 91300
Hospital Charge Code	606390386
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

PFIZBIONTCOVID19VACC ADM DOSE1

Facility

$50.00

Service Code	HCPCS 0001A
Hospital Charge Code	39500001A
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

PFIZBIONTCOVID19VACC ADM DOSE1

Facility

$50.00

Service Code	HCPCS 0001A
Hospital Charge Code	39500001A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZBIONTCOVID19VACC ADM DOSE2

Facility

$50.00

Service Code	HCPCS 0002A
Hospital Charge Code	39500002A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZBIONTCOVID19VACC ADM DOSE2

Facility

$50.00

Service Code	HCPCS 0002A
Hospital Charge Code	39500002A
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

PFIZBIONTCOVID19VACC ADM DOSE3

Facility

$50.00

Service Code	HCPCS 0003A
Hospital Charge Code	39500003A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZBIONTCOVID19VACC ADM DOSE3

Facility

$50.00

Service Code	HCPCS 0003A
Hospital Charge Code	39500003A
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

PFIZBIONTCOVID19VAXADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0004A
Hospital Charge Code	39500004A
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

PFIZBIONTCOVID19VAXADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0004A
Hospital Charge Code	39500004A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZBIONT PEDI COVID19 10MCG

Facility

$0.01

Service Code	HCPCS 91307
Hospital Charge Code	606390468
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

PFIZBIONT PEDI COVID19 10MCG

Facility

$0.01

Service Code	HCPCS 91307
Hospital Charge Code	606390468
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

PFIZCOV19BIVALADDLDOSEADM12YO

Facility

$50.00

Service Code	HCPCS 0121A
Hospital Charge Code	39500124A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZCOV19BIVALADDLDOSEADM12YO

Facility

$50.00

Service Code	HCPCS 0121A
Hospital Charge Code	39500124A
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

PFIZCOV19BIVALADLDOSEADM5TO11Y

Facility

$50.00

Service Code	HCPCS 0151A
Hospital Charge Code	39500154A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZCOV19BIVALADLDOSEADM5TO11Y

Facility

$50.00

Service Code	HCPCS 0151A
Hospital Charge Code	39500154A
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

PFIZER COV19 PEDS ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0074A
Hospital Charge Code	39500074A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZER COV19 PEDS ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0074A
Hospital Charge Code	39500074A
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

PFIZER COV19 PEDS ADMIN DOSE 1

Facility

$50.00

Service Code	HCPCS 0071A
Hospital Charge Code	39500071A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

Know your out-of-pocket cost for care.

All Charges