St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS A VACCINE 1440 EL U/ML IM SUSP

Facility

$99.29

Service Code	HCPCS 90632
Hospital Charge Code	5816082652
Hospital Revenue Code	250
Min. Negotiated Rate	$49.64
Max. Negotiated Rate	$49.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.64

HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP

Facility

$90.26

Service Code	NDC 0006409502
Hospital Charge Code	0006409502
Hospital Revenue Code	250
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$45.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.13

HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP

Facility

$90.26

Service Code	NDC 0006409502
Hospital Charge Code	0006409502
Hospital Revenue Code	250
Min. Negotiated Rate	$31.59
Max. Negotiated Rate	$72.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.13
Rate for Payer: Aetna Government	$45.13
Rate for Payer: Brighton Health Commercial	$67.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.38
Rate for Payer: EmblemHealth Commercial	$45.13
Rate for Payer: Group Health Inc Commercial	$45.13
Rate for Payer: Group Health Inc Medicare	$31.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.13
Rate for Payer: Hamaspik Choice Inc Medicare	$45.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.67

HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP

Facility

$90.92

Service Code	NDC 5816082552
Hospital Charge Code	5816082552
Hospital Revenue Code	250
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$72.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.46
Rate for Payer: Aetna Government	$45.46
Rate for Payer: Brighton Health Commercial	$68.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.83
Rate for Payer: EmblemHealth Commercial	$45.46
Rate for Payer: Group Health Inc Commercial	$45.46
Rate for Payer: Group Health Inc Medicare	$31.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.46
Rate for Payer: Hamaspik Choice Inc Medicare	$45.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.10

HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP

Facility

$90.92

Service Code	NDC 5816082552
Hospital Charge Code	5816082552
Hospital Revenue Code	250
Min. Negotiated Rate	$45.46
Max. Negotiated Rate	$45.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.46

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5ML IM SOSY

Facility

$212.28

Service Code	HCPCS 90371
Hospital Charge Code	1353363603
Hospital Revenue Code	250
Min. Negotiated Rate	$106.14
Max. Negotiated Rate	$106.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.14

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5ML IM SOSY

Facility

$212.28

Service Code	HCPCS 90371
Hospital Charge Code	1353363603
Hospital Revenue Code	250
Min. Negotiated Rate	$93.93
Max. Negotiated Rate	$169.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.19
Rate for Payer: Aetna Government	$134.19
Rate for Payer: Affinity Essential Plan 1&2	$93.93
Rate for Payer: Affinity Essential Plan 3&4	$93.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$93.93
Rate for Payer: Brighton Health Commercial	$159.21
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$134.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.35
Rate for Payer: Elderplan Medicare Advantage	$134.19
Rate for Payer: EmblemHealth Commercial	$134.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$120.77
Rate for Payer: Fidelis Essential Plan Aliesa	$114.06
Rate for Payer: Fidelis Essential Plan QHP	$119.43
Rate for Payer: Fidelis Medicare Advantage	$134.19
Rate for Payer: Fidelis Qualified Health Plan	$119.43
Rate for Payer: Group Health Inc Commercial	$134.19
Rate for Payer: Group Health Inc Medicare	$134.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.19
Rate for Payer: Hamaspik Choice Inc Medicare	$134.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$134.19
Rate for Payer: Healthfirst Medicare Advantage	$114.06
Rate for Payer: Healthfirst QHP	$134.19
Rate for Payer: Humana Medicare	$136.87
Rate for Payer: Senior Whole Health Medicare Advantage	$134.19
Rate for Payer: United Healthcare Medicare Advantage	$134.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$137.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.48
Rate for Payer: Wellcare Medicare	$127.48

HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SOSY

Facility

$200.15

Service Code	HCPCS 90371
Hospital Charge Code	1353363602
Hospital Revenue Code	250
Min. Negotiated Rate	$93.93
Max. Negotiated Rate	$160.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.19
Rate for Payer: Aetna Government	$134.19
Rate for Payer: Affinity Essential Plan 1&2	$93.93
Rate for Payer: Affinity Essential Plan 3&4	$93.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$93.93
Rate for Payer: Brighton Health Commercial	$150.11
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$134.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.10
Rate for Payer: Elderplan Medicare Advantage	$134.19
Rate for Payer: EmblemHealth Commercial	$134.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$120.77
Rate for Payer: Fidelis Essential Plan Aliesa	$114.06
Rate for Payer: Fidelis Essential Plan QHP	$119.43
Rate for Payer: Fidelis Medicare Advantage	$134.19
Rate for Payer: Fidelis Qualified Health Plan	$119.43
Rate for Payer: Group Health Inc Commercial	$134.19
Rate for Payer: Group Health Inc Medicare	$134.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.19
Rate for Payer: Hamaspik Choice Inc Medicare	$134.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$134.19
Rate for Payer: Healthfirst Medicare Advantage	$114.06
Rate for Payer: Healthfirst QHP	$134.19
Rate for Payer: Humana Medicare	$136.87
Rate for Payer: Senior Whole Health Medicare Advantage	$134.19
Rate for Payer: United Healthcare Medicare Advantage	$134.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.48
Rate for Payer: Wellcare Medicare	$127.48

HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SOSY

Facility

$200.15

Service Code	HCPCS 90371
Hospital Charge Code	1353363602
Hospital Revenue Code	250
Min. Negotiated Rate	$100.08
Max. Negotiated Rate	$100.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.08

HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY

Facility

$354.31

Service Code	HCPCS 90739
Hospital Charge Code	4352800305
Hospital Revenue Code	250
Min. Negotiated Rate	$124.01
Max. Negotiated Rate	$283.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.21
Rate for Payer: Aetna Government	$144.21
Rate for Payer: Brighton Health Commercial	$265.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.93
Rate for Payer: EmblemHealth Commercial	$177.16
Rate for Payer: Group Health Inc Commercial	$177.16
Rate for Payer: Group Health Inc Medicare	$124.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.16
Rate for Payer: Hamaspik Choice Inc Medicare	$177.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$177.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.30

HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY

Facility

$354.31

Service Code	HCPCS 90739
Hospital Charge Code	4352800305
Hospital Revenue Code	250
Min. Negotiated Rate	$177.16
Max. Negotiated Rate	$177.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.16

HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY

Facility

$354.32

Service Code	HCPCS 90739
Hospital Charge Code	4352800301
Hospital Revenue Code	250
Min. Negotiated Rate	$124.01
Max. Negotiated Rate	$283.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.21
Rate for Payer: Aetna Government	$144.21
Rate for Payer: Brighton Health Commercial	$265.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.94
Rate for Payer: EmblemHealth Commercial	$177.16
Rate for Payer: Group Health Inc Commercial	$177.16
Rate for Payer: Group Health Inc Medicare	$124.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.16
Rate for Payer: Hamaspik Choice Inc Medicare	$177.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$177.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.31

HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY

Facility

$354.32

Service Code	HCPCS 90739
Hospital Charge Code	4352800301
Hospital Revenue Code	250
Min. Negotiated Rate	$177.16
Max. Negotiated Rate	$177.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.16

HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY

Facility

$67.91

Service Code	HCPCS 90744
Hospital Charge Code	5816082052
Hospital Revenue Code	250
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$33.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.96

HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY

Facility

$67.91

Service Code	HCPCS 90744
Hospital Charge Code	5816082052
Hospital Revenue Code	250
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$54.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.22
Rate for Payer: Aetna Government	$28.22
Rate for Payer: Brighton Health Commercial	$50.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.18
Rate for Payer: EmblemHealth Commercial	$33.96
Rate for Payer: Group Health Inc Commercial	$33.96
Rate for Payer: Group Health Inc Medicare	$23.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.96
Rate for Payer: Hamaspik Choice Inc Medicare	$33.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.14

HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY

Facility

$0.01

Service Code	HCPCS 90744
Hospital Charge Code	5816082043
Hospital Revenue Code	250
Max. Negotiated Rate	$31.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.22
Rate for Payer: Aetna Government	$28.22
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: EmblemHealth Commercial	$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: Healthfirst CHP/FHP/Medicaid	$31.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY

Facility

$0.01

Service Code	HCPCS 90744
Hospital Charge Code	5816082043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

HEPATITIS B VAC RECOMBINANT 10 MCG/0.5 ML IJ SUSY VFC

Facility

$0.01

Service Code	HCPCS 90744
Hospital Charge Code	5816082043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

HEPATITIS B VAC RECOMBINANT 10 MCG/0.5 ML IJ SUSY VFC

Facility

$0.01

Service Code	HCPCS 90744
Hospital Charge Code	5816082043
Hospital Revenue Code	250
Max. Negotiated Rate	$31.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.22
Rate for Payer: Aetna Government	$28.22
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: EmblemHealth Commercial	$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: Healthfirst CHP/FHP/Medicaid	$31.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

HEPATITIS B VAC RECOMBINANT 10 MCG/ML IJ SUSP

Facility

$80.04

Service Code	NDC 0006499541
Hospital Charge Code	0006499541
Hospital Revenue Code	250
Min. Negotiated Rate	$40.02
Max. Negotiated Rate	$40.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.02

HEPATITIS B VAC RECOMBINANT 10 MCG/ML IJ SUSP

Facility

$80.04

Service Code	NDC 0006499541
Hospital Charge Code	0006499541
Hospital Revenue Code	250
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$64.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.02
Rate for Payer: Aetna Government	$40.02
Rate for Payer: Brighton Health Commercial	$60.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.43
Rate for Payer: EmblemHealth Commercial	$40.02
Rate for Payer: Group Health Inc Commercial	$40.02
Rate for Payer: Group Health Inc Medicare	$28.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.02
Rate for Payer: Hamaspik Choice Inc Medicare	$40.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.03

HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP

Facility

$83.24

Service Code	NDC 5816082101
Hospital Charge Code	5816082101
Hospital Revenue Code	250
Min. Negotiated Rate	$29.13
Max. Negotiated Rate	$66.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.62
Rate for Payer: Aetna Government	$41.62
Rate for Payer: Brighton Health Commercial	$62.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.60
Rate for Payer: EmblemHealth Commercial	$41.62
Rate for Payer: Group Health Inc Commercial	$41.62
Rate for Payer: Group Health Inc Medicare	$29.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.62
Rate for Payer: Hamaspik Choice Inc Medicare	$41.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.10

HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP

Facility

$83.24

Service Code	NDC 5816082101
Hospital Charge Code	5816082101
Hospital Revenue Code	250
Min. Negotiated Rate	$41.62
Max. Negotiated Rate	$41.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.62

HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP

Facility

$83.24

Service Code	NDC 5816082111
Hospital Charge Code	5816082111
Hospital Revenue Code	250
Min. Negotiated Rate	$41.62
Max. Negotiated Rate	$41.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.62

HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP

Facility

$83.24

Service Code	NDC 5816082111
Hospital Charge Code	5816082111
Hospital Revenue Code	250
Min. Negotiated Rate	$29.13
Max. Negotiated Rate	$66.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.62
Rate for Payer: Aetna Government	$41.62
Rate for Payer: Brighton Health Commercial	$62.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.60
Rate for Payer: EmblemHealth Commercial	$41.62
Rate for Payer: Group Health Inc Commercial	$41.62
Rate for Payer: Group Health Inc Medicare	$29.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.62
Rate for Payer: Hamaspik Choice Inc Medicare	$41.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.10

Know your out-of-pocket cost for care.

All Charges