Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CL- FLUCELVAX 6 MO - 64 YEARS

Facility

OP

$90.00

Service Code	HCPCS 90661
Hospital Charge Code	4490661
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUCELVAX 6 MO - 64 YEARS

Facility

IP

$90.00

Service Code	HCPCS 90656
Hospital Charge Code	9890656
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUCELVAX 6 MO - 64 YEARS

Facility

IP

$90.00

Service Code	HCPCS 90661
Hospital Charge Code	4490661
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUCELVAX 6 MO - 64 YEARS

Facility

IP

$90.00

Service Code	HCPCS 90656
Hospital Charge Code	4490656
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL-FLUCELVAX 6 MO - 64 YEARS

Facility

IP

$90.00

Service Code	HCPCS 90661
Hospital Charge Code	3990661
Hospital Revenue Code	771
Rate for Payer: Cash Price	$81.00

CL-FLUCELVAX 6 MO - 64 YEARS

Facility

IP

$90.00

Service Code	HCPCS 90656
Hospital Charge Code	3990656
Hospital Revenue Code	771
Rate for Payer: Cash Price	$81.00

CL-FLUCELVAX 6 MO - 64 YEARS

Facility

OP

$90.00

Service Code	HCPCS 90656
Hospital Charge Code	3990656
Hospital Revenue Code	771
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL-FLUCELVAX 6 MO - 64 YEARS

Facility

OP

$90.00

Service Code	HCPCS 90661
Hospital Charge Code	3990661
Hospital Revenue Code	771
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL - FLUCELVAX 6 MO - 65 YEARS

Facility

IP

$90.00

Service Code	HCPCS 90661
Hospital Charge Code	9290661
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL - FLUCELVAX 6 MO - 65 YEARS

Facility

IP

$90.00

Service Code	HCPCS 90656
Hospital Charge Code	9690656
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL - FLUCELVAX 6 MO - 65 YEARS

Facility

IP

$90.00

Service Code	HCPCS 90656
Hospital Charge Code	9290656
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL - FLUCELVAX 6 MO - 65 YEARS

Facility

OP

$90.00

Service Code	HCPCS 90661
Hospital Charge Code	9290661
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL - FLUCELVAX 6 MO - 65 YEARS

Facility

OP

$90.00

Service Code	HCPCS 90656
Hospital Charge Code	9290656
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL - FLUCELVAX 6 MO - 65 YEARS

Facility

OP

$90.00

Service Code	HCPCS 90656
Hospital Charge Code	9690656
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL - FLUZONE 6 MO +

Facility

OP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	9690686
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL - FLUZONE 6 MO +

Facility

IP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	9690686
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUZONE 6 MO +

Facility

IP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	9890686
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUZONE 6 MO +

Facility

OP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	4490686
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUZONE 6 MO +

Facility

IP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	9490686
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUZONE 6 MO +

Facility

OP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	9490686
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUZONE 6 MO +

Facility

IP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	4490686
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUZONE 6 MO +

Facility

OP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	9890686
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUZONE 6 MO +

Facility

IP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	4290686
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

CL- FLUZONE 6 MO +

Facility

OP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	4290686
Hospital Revenue Code	636
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

CL- FLUZONE 6 MO+

Facility

IP

$90.00

Service Code	HCPCS 90686
Hospital Charge Code	9790686
Hospital Revenue Code	636
Min. Negotiated Rate	$60.03
Max. Negotiated Rate	$60.03
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03

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