Heights University Hospital

All Charges

Charge

Type

Setting

Price

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	87502260
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	911031
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	5700285
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	83090025
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	83090025
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	5700285
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	93950061
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	93950061
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	911031
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN INITIAL

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	87502260
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMINISTRATION 1ST VAC

Facility

$206.86

Service Code	HCPCS 90471
Hospital Charge Code	3408010
Hospital Revenue Code	771
Min. Negotiated Rate	$21.85
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$62.06
Rate for Payer: Aetna Medicare Advantage	$62.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.75
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.89
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.03
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMINISTRATION 1ST VAC

Facility

$206.86

Service Code	HCPCS 90471
Hospital Charge Code	3408010
Hospital Revenue Code	771
Min. Negotiated Rate	$31.03
Max. Negotiated Rate	$31.03
Rate for Payer: Qualcare PPO/HMO/WC	$31.03

VACCINE ADMIN PNEUMO

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	100142
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN PNEUMO

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	93500179
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN PNEUMO

Facility

$260.00

Service Code	HCPCS 90471
Hospital Charge Code	73237029
Hospital Revenue Code	771
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

VACCINE ADMIN PNEUMO

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	87502055
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN PNEUMO

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	87502055
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN PNEUMO

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	911030
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN PNEUMO

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	260121
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN PNEUMO

Facility

$260.00

Service Code	HCPCS 90471
Hospital Charge Code	73237029
Hospital Revenue Code	771
Min. Negotiated Rate	$21.85
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$78.00
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN PNEUMO

Facility

$41.00

Service Code	HCPCS 90471
Hospital Charge Code	84206165
Hospital Revenue Code	771
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN PNEUMO

Facility

$156.00

Service Code	HCPCS 90471
Hospital Charge Code	3408045
Hospital Revenue Code	771
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

VACCINE ADMIN PNEUMO

Facility

$156.00

Service Code	HCPCS 90471
Hospital Charge Code	3408045
Hospital Revenue Code	771
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$46.80
Rate for Payer: Aetna Medicare Advantage	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.78
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.28
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN PNEUMO

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	83652521
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN PNEUMO

Facility

$89.07

Service Code	HCPCS 90471
Hospital Charge Code	911030
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

Know your out-of-pocket cost for care.

All Charges