St. Barnabas Hospital

All Charges

Charge

Type

Price

FLUZONE ID 0.1ML SYR

Facility IP

$32.22

Service Code	HCPCS 90654
Hospital Charge Code	41647079
Hospital Revenue Code	636
Min. Negotiated Rate	$16.11
Max. Negotiated Rate	$16.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.11
Rate for Payer: Hamaspik Choice Inc Medicare	$16.11

FLUZONE ID 0.1ML SYR

Facility IP

$32.22

Service Code	HCPCS 90654
Hospital Charge Code	41657079
Hospital Revenue Code	636
Min. Negotiated Rate	$16.11
Max. Negotiated Rate	$16.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.11
Rate for Payer: Hamaspik Choice Inc Medicare	$16.11

FLUZONE ID 0.1ML SYR

Facility OP

$32.22

Service Code	HCPCS 90654
Hospital Charge Code	41657079
Hospital Revenue Code	636
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$20.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.92
Rate for Payer: Aetna Government	$16.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.53
Rate for Payer: Group Health Inc Commercial	$16.11
Rate for Payer: Group Health Inc Medicare	$11.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.11
Rate for Payer: Hamaspik Choice Inc Medicare	$16.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.94

FLUZONE ID 0.1ML SYR

Facility OP

$32.22

Service Code	HCPCS 90654
Hospital Charge Code	41647079
Hospital Revenue Code	636
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$20.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.92
Rate for Payer: Aetna Government	$16.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.53
Rate for Payer: Group Health Inc Commercial	$16.11
Rate for Payer: Group Health Inc Medicare	$11.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.11
Rate for Payer: Hamaspik Choice Inc Medicare	$16.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.94

FLUZONE PED 0.25ML SYR

Facility OP

$24.90

Service Code	HCPCS 90685
Hospital Charge Code	41655564
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$21.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.64
Rate for Payer: Aetna Government	$21.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.32
Rate for Payer: Group Health Inc Commercial	$12.45
Rate for Payer: Group Health Inc Medicare	$8.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.18

FLUZONE PED 0.25ML SYR

Facility OP

$24.90

Service Code	HCPCS 90685
Hospital Charge Code	41645564
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$21.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.64
Rate for Payer: Aetna Government	$21.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.32
Rate for Payer: Group Health Inc Commercial	$12.45
Rate for Payer: Group Health Inc Medicare	$8.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.18

FLUZONE PED 0.25ML SYR

Facility IP

$24.90

Service Code	HCPCS 90685
Hospital Charge Code	41645564
Hospital Revenue Code	636
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45

FLUZONE PED 0.25ML SYR

Facility IP

$24.90

Service Code	HCPCS 90685
Hospital Charge Code	41655564
Hospital Revenue Code	636
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45

FLUZONE QUAD 0.25ML PFS, 6-35MO

Facility IP

$24.90

Service Code	HCPCS 90685
Hospital Charge Code	41645729
Hospital Revenue Code	636
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45

FLUZONE QUAD 0.25ML PFS, 6-35MO

Facility OP

$24.90

Service Code	HCPCS 90685
Hospital Charge Code	41645729
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$21.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.64
Rate for Payer: Aetna Government	$21.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.32
Rate for Payer: Group Health Inc Commercial	$12.45
Rate for Payer: Group Health Inc Medicare	$8.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.18

FLUZONE QUAD 0.5ML PFS, IM 3 YRS+

Facility OP

$15.88

Service Code	HCPCS 90686
Hospital Charge Code	41645727
Hospital Revenue Code	636
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$23.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.53
Rate for Payer: Aetna Government	$20.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.37
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.32

FLUZONE QUAD 0.5ML PFS, IM 3 YRS+

Facility IP

$15.88

Service Code	HCPCS 90686
Hospital Charge Code	41645727
Hospital Revenue Code	636
Min. Negotiated Rate	$7.94
Max. Negotiated Rate	$7.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

FLUZONE QUAD 0.5ML SYR

Facility IP

$15.88

Service Code	HCPCS 90686
Hospital Charge Code	41655727
Hospital Revenue Code	636
Min. Negotiated Rate	$7.94
Max. Negotiated Rate	$7.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

FLUZONE QUAD 0.5ML SYR

Facility OP

$15.88

Service Code	HCPCS 90686
Hospital Charge Code	41655727
Hospital Revenue Code	636
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$23.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.53
Rate for Payer: Aetna Government	$20.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.37
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.32

FLUZONE QUAD IM MDV-3 YRS+

Facility IP

$32.00

Service Code	HCPCS 90688
Hospital Charge Code	41655969
Hospital Revenue Code	636
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00

FLUZONE QUAD IM MDV-3 YRS+

Facility OP

$32.00

Service Code	HCPCS 90688
Hospital Charge Code	41655969
Hospital Revenue Code	636
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$22.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.91
Rate for Payer: Aetna Government	$19.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.43
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22.13
Rate for Payer: SOMOS Essential	$22.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.80

FLUZONE QUAD IM MDV-3YRS+

Facility IP

$32.00

Service Code	HCPCS 90688
Hospital Charge Code	41645969
Hospital Revenue Code	636
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00

FLUZONE QUAD IM MDV-3YRS+

Facility OP

$32.00

Service Code	HCPCS 90688
Hospital Charge Code	41645969
Hospital Revenue Code	636
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$22.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.91
Rate for Payer: Aetna Government	$19.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.43
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22.13
Rate for Payer: SOMOS Essential	$22.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.80

FLUZONE QUAD PED 0.25ML SYR

Facility IP

$24.90

Service Code	HCPCS 90686
Hospital Charge Code	41655729
Hospital Revenue Code	636
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45

FLUZONE QUAD PED 0.25ML SYR

Facility OP

$24.90

Service Code	HCPCS 90686
Hospital Charge Code	41655729
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$23.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.53
Rate for Payer: Aetna Government	$20.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.37
Rate for Payer: Group Health Inc Commercial	$12.45
Rate for Payer: Group Health Inc Medicare	$8.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.18

FLUZONE QUAD (VFC)0.5ML PFS 3+YRS

Facility OP

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	41655961
Hospital Revenue Code	636
Max. Negotiated Rate	$23.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.53
Rate for Payer: Aetna Government	$20.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.37
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: Healthfirst CHP/FHP/Medicaid	$21.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

FLUZONE QUAD (VFC)0.5ML PFS 3+YRS

Facility OP

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	41645961
Hospital Revenue Code	636
Max. Negotiated Rate	$23.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.53
Rate for Payer: Aetna Government	$20.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.37
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: Healthfirst CHP/FHP/Medicaid	$21.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

FLUZONE QUAD (VFC)0.5ML PFS 3+YRS

Facility IP

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	41645961
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

FLUZONE QUAD (VFC)0.5ML PFS 3+YRS

Facility IP

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	41655961
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

FL VIDEO ESOPHAGUS

Facility OP

$551.90

Service Code	HCPCS 74230 TC
Hospital Charge Code	41102500
Hospital Revenue Code	320
Min. Negotiated Rate	$113.44
Max. Negotiated Rate	$441.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.95
Rate for Payer: Aetna Government	$275.95
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$441.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$375.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$113.44
Rate for Payer: Group Health Inc Commercial	$275.95
Rate for Payer: Group Health Inc Medicare	$193.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$275.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$126.05

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