St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MENINGOCOCCAL B OMV VACC IM (VFC)

Facility

$0.01

Service Code	HCPCS 90620
Hospital Charge Code	41646596
Hospital Revenue Code	250
Max. Negotiated Rate	$195.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.45
Rate for Payer: Aetna Government	$195.45
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MENINGOCOCCAL B OMV VACC IM (VFC)

Facility

$0.01

Service Code	HCPCS 90620
Hospital Charge Code	41656596
Hospital Revenue Code	636
Max. Negotiated Rate	$195.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.45
Rate for Payer: Aetna Government	$195.45
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY [127348]

Facility

$536.69

Service Code	NDC 58160097620
Hospital Charge Code	58160097620
Hospital Revenue Code	250
Min. Negotiated Rate	$187.84
Max. Negotiated Rate	$429.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$295.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$268.34
Rate for Payer: Aetna Government	$268.34
Rate for Payer: Brighton Health Commercial	$402.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$429.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$364.95
Rate for Payer: Group Health Inc Commercial	$268.34
Rate for Payer: Group Health Inc Medicare	$187.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$268.34
Rate for Payer: Hamaspik Choice Inc Medicare	$268.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$348.85

MENINGOCOCCAL B VAC (RECOMB) IM SUSY [127603]

Facility

$456.33

Service Code	NDC 00005010005
Hospital Charge Code	00005010005
Hospital Revenue Code	250
Min. Negotiated Rate	$159.71
Max. Negotiated Rate	$365.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$228.16
Rate for Payer: Aetna Government	$228.16
Rate for Payer: Brighton Health Commercial	$342.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$365.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$310.30
Rate for Payer: Group Health Inc Commercial	$228.16
Rate for Payer: Group Health Inc Medicare	$159.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.16
Rate for Payer: Hamaspik Choice Inc Medicare	$228.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$296.61

MENINGOCOCCAL CONJUGATE VFC

Facility

$0.01

Service Code	HCPCS 90619
Hospital Charge Code	41650264
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

MENINGOCOCCAL CONJUGATE VFC

Facility

$0.01

Service Code	HCPCS 90619
Hospital Charge Code	41640264
Hospital Revenue Code	636
Max. Negotiated Rate	$144.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.13
Rate for Payer: Aetna Government	$144.13
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MENINGOCOCCAL CONJUGATE VFC

Facility

$0.01

Service Code	HCPCS 90619
Hospital Charge Code	41640264
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

MENINGOCOCCAL CONJUGATE VFC

Facility

$0.01

Service Code	HCPCS 90619
Hospital Charge Code	41650264
Hospital Revenue Code	636
Max. Negotiated Rate	$144.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.13
Rate for Payer: Aetna Government	$144.13
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MENINGOCOCCAL VACC 0.5ML IM

Facility

$329.00

Service Code	HCPCS 90734
Hospital Charge Code	41649582
Hospital Revenue Code	636
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50

MENINGOCOCCAL VACC 0.5ML IM

Facility

$329.00

Service Code	HCPCS 90734
Hospital Charge Code	41659582
Hospital Revenue Code	636
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50

MENINGOCOCCAL VACC 0.5ML IM

Facility

$329.00

Service Code	HCPCS 90734
Hospital Charge Code	41659582
Hospital Revenue Code	636
Min. Negotiated Rate	$115.15
Max. Negotiated Rate	$213.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$180.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.33
Rate for Payer: Aetna Government	$137.33
Rate for Payer: Brighton Health Commercial	$197.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.18
Rate for Payer: Group Health Inc Commercial	$164.50
Rate for Payer: Group Health Inc Medicare	$115.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$213.85

MENINGOCOCCAL VACC 0.5ML IM

Facility

$329.00

Service Code	HCPCS 90734
Hospital Charge Code	41649582
Hospital Revenue Code	636
Min. Negotiated Rate	$115.15
Max. Negotiated Rate	$213.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$180.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.33
Rate for Payer: Aetna Government	$137.33
Rate for Payer: Brighton Health Commercial	$197.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.18
Rate for Payer: Group Health Inc Commercial	$164.50
Rate for Payer: Group Health Inc Medicare	$115.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$213.85

MENINGOCOCCAL VACCINE (MENACTRA) INJ

Facility

$329.00

Hospital Charge Code	41643996
Hospital Revenue Code	636
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50

MENINGOCOCCAL VACCINE (MENACTRA) INJ

Facility

$329.00

Hospital Charge Code	41643996
Hospital Revenue Code	636
Min. Negotiated Rate	$115.15
Max. Negotiated Rate	$213.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$180.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$164.50
Rate for Payer: Aetna Government	$164.50
Rate for Payer: Brighton Health Commercial	$197.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.18
Rate for Payer: Group Health Inc Commercial	$164.50
Rate for Payer: Group Health Inc Medicare	$115.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$213.85

MENINGOCOCCAL VACCINE (MENACTRA) INJ

Facility

$329.00

Hospital Charge Code	41653996
Hospital Revenue Code	636
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50

MENINGOCOCCAL VACCINE (MENACTRA) INJ

Facility

$329.00

Hospital Charge Code	41653996
Hospital Revenue Code	636
Min. Negotiated Rate	$115.15
Max. Negotiated Rate	$213.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$180.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$164.50
Rate for Payer: Aetna Government	$164.50
Rate for Payer: Brighton Health Commercial	$197.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.18
Rate for Payer: Group Health Inc Commercial	$164.50
Rate for Payer: Group Health Inc Medicare	$115.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$213.85

MENINGOCOCCAL VACCINE (MENOMUNE) INJ

Facility

$345.00

Service Code	HCPCS 90733
Hospital Charge Code	41642151
Hospital Revenue Code	636
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$224.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.50
Rate for Payer: Aetna Government	$125.50
Rate for Payer: Brighton Health Commercial	$207.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.38
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

MENINGOCOCCAL VACCINE (MENOMUNE) INJ

Facility

$345.00

Service Code	HCPCS 90733
Hospital Charge Code	41642151
Hospital Revenue Code	636
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

MENINGOCOCCAL VACCINE (MENOMUNE) INJ

Facility

$345.00

Service Code	HCPCS 90733
Hospital Charge Code	41652151
Hospital Revenue Code	636
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50

MENINGOCOCCAL VACCINE (MENOMUNE) INJ

Facility

$345.00

Service Code	HCPCS 90733
Hospital Charge Code	41652151
Hospital Revenue Code	636
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$224.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.50
Rate for Payer: Aetna Government	$125.50
Rate for Payer: Brighton Health Commercial	$207.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.38
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

MENINGOCOCCAL VACC (MENVEO - VFC)

Facility

$0.01

Service Code	HCPCS 90734
Hospital Charge Code	41655871
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

MENINGOCOCCAL VACC (MENVEO - VFC)

Facility

$0.01

Service Code	HCPCS 90734
Hospital Charge Code	41655871
Hospital Revenue Code	636
Max. Negotiated Rate	$137.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.33
Rate for Payer: Aetna Government	$137.33
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MENINGOCOCCAL VACC (MENVEO-VFC)

Facility

$0.01

Service Code	HCPCS 90734
Hospital Charge Code	41645871
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

MENINGOCOCCAL VACC (MENVEO-VFC)

Facility

$0.01

Service Code	HCPCS 90734
Hospital Charge Code	41645871
Hospital Revenue Code	636
Max. Negotiated Rate	$137.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.33
Rate for Payer: Aetna Government	$137.33
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MENINGOCOCCAL VACC (VFC) 0.5ML IM

Facility

$0.01

Service Code	HCPCS 90734
Hospital Charge Code	41649563
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

Know your out-of-pocket cost for care.

All Charges