St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLUZONE 0.5ML SYRINGE

Facility

$24.90

Service Code	HCPCS 90658
Hospital Charge Code	41645561
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 0.5ML SYRINGE

Facility

$24.90

Service Code	HCPCS 90658
Hospital Charge Code	41655561
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$1,148.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.32
Rate for Payer: Aetna Government	$16.32
Rate for Payer: Affinity Essential Plan 1&2	$25.83
Rate for Payer: Affinity Essential Plan 3&4	$25.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.48
Rate for Payer: Amida Care Medicaid	$11.48
Rate for Payer: Brighton Health Commercial	$14.94
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	$1,148.00
Rate for Payer: Fidelis Essential Plan Aliesa	$11.48
Rate for Payer: Fidelis Essential Plan QHP	$11.48
Rate for Payer: Fidelis Qualified Health Plan	$12.05
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	$11.48
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.48
Rate for Payer: Healthfirst Essential Plan	$25.83
Rate for Payer: Healthfirst QHP	$11.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11.48
Rate for Payer: SOMOS Essential	$11.48
Rate for Payer: United Healthcare Essential Plan 1&2	$25.83
Rate for Payer: United Healthcare Essential Plan 3&4	$12.63
Rate for Payer: United Healthcare Medicaid	$11.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.48

FLUZONE 0.5ML SYRINGE

Facility

$24.90

Service Code	HCPCS 90658
Hospital Charge Code	41655561
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 0.5ML SYRINGE

Facility

$24.90

Service Code	HCPCS 90658
Hospital Charge Code	41645561
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$1,148.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.32
Rate for Payer: Aetna Government	$16.32
Rate for Payer: Affinity Essential Plan 1&2	$25.83
Rate for Payer: Affinity Essential Plan 3&4	$25.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.48
Rate for Payer: Amida Care Medicaid	$11.48
Rate for Payer: Brighton Health Commercial	$14.94
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	$1,148.00
Rate for Payer: Fidelis Essential Plan Aliesa	$11.48
Rate for Payer: Fidelis Essential Plan QHP	$11.48
Rate for Payer: Fidelis Qualified Health Plan	$12.05
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	$11.48
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.48
Rate for Payer: Healthfirst Essential Plan	$25.83
Rate for Payer: Healthfirst QHP	$11.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11.48
Rate for Payer: SOMOS Essential	$11.48
Rate for Payer: United Healthcare Essential Plan 1&2	$25.83
Rate for Payer: United Healthcare Essential Plan 3&4	$12.63
Rate for Payer: United Healthcare Medicaid	$11.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.48

FLUZONE HIGH DOSE .5ML

Facility

$111.58

Service Code	HCPCS 90662
Hospital Charge Code	41647076
Hospital Revenue Code	636
Min. Negotiated Rate	$39.05
Max. Negotiated Rate	$77.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.26
Rate for Payer: Aetna Government	$65.26
Rate for Payer: Brighton Health Commercial	$66.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.16
Rate for Payer: Group Health Inc Commercial	$55.79
Rate for Payer: Group Health Inc Medicare	$39.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.79
Rate for Payer: Hamaspik Choice Inc Medicare	$55.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.81
Rate for Payer: SOMOS Essential	$77.81
Rate for Payer: United Healthcare Commercial	$69.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.53

FLUZONE HIGH DOSE .5ML

Facility

$111.58

Service Code	HCPCS 90662
Hospital Charge Code	41657076
Hospital Revenue Code	636
Min. Negotiated Rate	$55.79
Max. Negotiated Rate	$55.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.79
Rate for Payer: Hamaspik Choice Inc Medicare	$55.79

FLUZONE HIGH DOSE .5ML

Facility

$111.58

Service Code	HCPCS 90662
Hospital Charge Code	41657076
Hospital Revenue Code	636
Min. Negotiated Rate	$39.05
Max. Negotiated Rate	$77.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.26
Rate for Payer: Aetna Government	$65.26
Rate for Payer: Brighton Health Commercial	$66.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.16
Rate for Payer: Group Health Inc Commercial	$55.79
Rate for Payer: Group Health Inc Medicare	$39.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.79
Rate for Payer: Hamaspik Choice Inc Medicare	$55.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.81
Rate for Payer: SOMOS Essential	$77.81
Rate for Payer: United Healthcare Commercial	$69.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.53

FLUZONE HIGH DOSE .5ML

Facility

$111.58

Service Code	HCPCS 90662
Hospital Charge Code	41647076
Hospital Revenue Code	636
Min. Negotiated Rate	$55.79
Max. Negotiated Rate	$55.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.79
Rate for Payer: Hamaspik Choice Inc Medicare	$55.79

FLUZONE ID 0.1ML SYR

Facility

$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: Brighton Health Commercial	$19.33
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

$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

$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: Brighton Health Commercial	$19.33
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

$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 PED 0.25ML SYR

Facility

$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: Brighton Health Commercial	$14.94
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

$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 PED 0.25ML SYR

Facility

$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: Brighton Health Commercial	$14.94
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

$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 QUAD 0.25ML PFS, 6-35MO

Facility

$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: Brighton Health Commercial	$14.94
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 0.25ML PFS, 6-35MO

Facility

$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 0.5ML PFS, IM 3 YRS+

Facility

$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 PFS, IM 3 YRS+

Facility

$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: Brighton Health Commercial	$9.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.13
Rate for Payer: 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: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: United Healthcare Commercial	$21.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.32

FLUZONE QUAD 0.5ML SYR

Facility

$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

$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: Brighton Health Commercial	$9.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.13
Rate for Payer: 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: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: United Healthcare Commercial	$21.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.32

FLUZONE QUAD IM MDV-3 YRS+

Facility

$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: Brighton Health Commercial	$19.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.40
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: SOMOS CHP/HARP/Medicaid	$22.13
Rate for Payer: SOMOS Essential	$22.13
Rate for Payer: United Healthcare Commercial	$20.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.80

FLUZONE QUAD IM MDV-3 YRS+

Facility

$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-3YRS+

Facility

$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

Know your out-of-pocket cost for care.

All Charges