St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DIPHTHERIA + TETANUS + PERTUSSIS INJ SYR

Facility

$74.00

Hospital Charge Code	41644130
Hospital Revenue Code	636
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$48.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.00
Rate for Payer: Aetna Government	$37.00
Rate for Payer: Brighton Health Commercial	$44.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.55
Rate for Payer: Group Health Inc Commercial	$37.00
Rate for Payer: Group Health Inc Medicare	$25.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$37.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.10

DIPHTHERIA + TETANUS + PERTUSSIS INJ SYR

Facility

$74.00

Hospital Charge Code	41654130
Hospital Revenue Code	636
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$48.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.00
Rate for Payer: Aetna Government	$37.00
Rate for Payer: Brighton Health Commercial	$44.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.55
Rate for Payer: Group Health Inc Commercial	$37.00
Rate for Payer: Group Health Inc Medicare	$25.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$37.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.10

DIPHTHERIA + TETANUS + PERTUSSIS INJ SYR

Facility

$74.00

Hospital Charge Code	41644130
Hospital Revenue Code	636
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$37.00

DIPHTHERIA + TETANUS + PERTUSSIS INJ SYR

Facility

$74.00

Hospital Charge Code	41654130
Hospital Revenue Code	636
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$37.00

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$94.10

Hospital Charge Code	41655060
Hospital Revenue Code	250
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$75.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.05
Rate for Payer: Aetna Government	$47.05
Rate for Payer: Brighton Health Commercial	$70.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.99
Rate for Payer: Group Health Inc Commercial	$47.05
Rate for Payer: Group Health Inc Medicare	$32.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.05
Rate for Payer: Hamaspik Choice Inc Medicare	$47.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.16

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$135.98

Hospital Charge Code	41653275
Hospital Revenue Code	636
Min. Negotiated Rate	$67.99
Max. Negotiated Rate	$67.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.99
Rate for Payer: Hamaspik Choice Inc Medicare	$67.99

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$135.98

Service Code	HCPCS 90723
Hospital Charge Code	41643275
Hospital Revenue Code	636
Min. Negotiated Rate	$47.59
Max. Negotiated Rate	$93.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$93.35
Rate for Payer: Aetna Government	$93.35
Rate for Payer: Brighton Health Commercial	$81.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.19
Rate for Payer: Group Health Inc Commercial	$67.99
Rate for Payer: Group Health Inc Medicare	$47.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.99
Rate for Payer: Hamaspik Choice Inc Medicare	$67.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.39

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$103.00

Service Code	HCPCS 90698
Hospital Charge Code	41645057
Hospital Revenue Code	636
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$105.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.11
Rate for Payer: Aetna Government	$105.11
Rate for Payer: Brighton Health Commercial	$61.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.22
Rate for Payer: Group Health Inc Commercial	$51.50
Rate for Payer: Group Health Inc Medicare	$36.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.95

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$103.00

Service Code	HCPCS 90698
Hospital Charge Code	41655057
Hospital Revenue Code	636
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$105.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.11
Rate for Payer: Aetna Government	$105.11
Rate for Payer: Brighton Health Commercial	$61.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.22
Rate for Payer: Group Health Inc Commercial	$51.50
Rate for Payer: Group Health Inc Medicare	$36.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.95

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$135.98

Service Code	HCPCS 90723
Hospital Charge Code	41643275
Hospital Revenue Code	636
Min. Negotiated Rate	$67.99
Max. Negotiated Rate	$67.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.99
Rate for Payer: Hamaspik Choice Inc Medicare	$67.99

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$103.00

Service Code	HCPCS 90698
Hospital Charge Code	41645057
Hospital Revenue Code	636
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$51.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$94.10

Hospital Charge Code	41645060
Hospital Revenue Code	250
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$75.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.05
Rate for Payer: Aetna Government	$47.05
Rate for Payer: Brighton Health Commercial	$70.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.99
Rate for Payer: Group Health Inc Commercial	$47.05
Rate for Payer: Group Health Inc Medicare	$32.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.05
Rate for Payer: Hamaspik Choice Inc Medicare	$47.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.16

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$135.98

Hospital Charge Code	41653275
Hospital Revenue Code	636
Min. Negotiated Rate	$47.59
Max. Negotiated Rate	$88.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.99
Rate for Payer: Aetna Government	$67.99
Rate for Payer: Brighton Health Commercial	$81.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.19
Rate for Payer: Group Health Inc Commercial	$67.99
Rate for Payer: Group Health Inc Medicare	$47.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.99
Rate for Payer: Hamaspik Choice Inc Medicare	$67.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.39

DIPHTHERIA + TETANUS + PERTUSSIS + POLIO

Facility

$103.00

Service Code	HCPCS 90698
Hospital Charge Code	41655057
Hospital Revenue Code	636
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$51.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50

DIPHTHERIA + TETANUS TOXOID INJ PEDIATRI

Facility

$61.00

Hospital Charge Code	41653708
Hospital Revenue Code	636
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$39.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.50
Rate for Payer: Aetna Government	$30.50
Rate for Payer: Brighton Health Commercial	$36.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.08
Rate for Payer: Group Health Inc Commercial	$30.50
Rate for Payer: Group Health Inc Medicare	$21.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.65

DIPHTHERIA + TETANUS TOXOID INJ PEDIATRI

Facility

$61.00

Hospital Charge Code	41653708
Hospital Revenue Code	636
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$30.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50

DIPHTHERIA + TETANUS TOXOID INJ PEDIATRI

Facility

$61.00

Hospital Charge Code	41643708
Hospital Revenue Code	636
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$39.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.50
Rate for Payer: Aetna Government	$30.50
Rate for Payer: Brighton Health Commercial	$36.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.08
Rate for Payer: Group Health Inc Commercial	$30.50
Rate for Payer: Group Health Inc Medicare	$21.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.65

DIPHTHERIA + TETANUS TOXOID INJ PEDIATRI

Facility

$61.00

Hospital Charge Code	41643708
Hospital Revenue Code	636
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$30.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50

DIPHTHERIA + TETANUS TOXOID INJ SYR ADUL

Facility

$34.00

Service Code	HCPCS 90714
Hospital Charge Code	41653864
Hospital Revenue Code	636
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

DIPHTHERIA + TETANUS TOXOID INJ SYR ADUL

Facility

$34.00

Service Code	HCPCS 90714
Hospital Charge Code	41643864
Hospital Revenue Code	636
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$20.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.55
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

DIPHTHERIA + TETANUS TOXOID INJ SYR ADUL

Facility

$34.00

Service Code	HCPCS 90714
Hospital Charge Code	41653864
Hospital Revenue Code	636
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$20.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.55
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

DIPHTHERIA + TETANUS TOXOID INJ SYR ADUL

Facility

$34.00

Service Code	HCPCS 90714
Hospital Charge Code	41643864
Hospital Revenue Code	636
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

DIPHTHERIA + TETANUS TOXOIDS INJ ADULT

Facility

$34.00

Service Code	HCPCS 90714
Hospital Charge Code	41654588
Hospital Revenue Code	636
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

DIPHTHERIA + TETANUS TOXOIDS INJ ADULT

Facility

$34.00

Service Code	HCPCS 90714
Hospital Charge Code	41644588
Hospital Revenue Code	636
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

DIPHTHERIA + TETANUS TOXOIDS INJ ADULT

Facility

$34.00

Service Code	HCPCS 90714
Hospital Charge Code	41654588
Hospital Revenue Code	636
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$20.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.55
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

Know your out-of-pocket cost for care.

All Charges