St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS A IGM

Facility

$28.15

Service Code	HCPCS 86709
Hospital Charge Code	40717048
Hospital Revenue Code	302
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$21.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.26
Rate for Payer: Aetna Government	$11.26
Rate for Payer: Affinity Essential Plan 1&2	$7.88
Rate for Payer: Affinity Essential Plan 3&4	$7.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.88
Rate for Payer: Brighton Health Commercial	$21.11
Rate for Payer: Cash Price	$11.26
Rate for Payer: Cash Price	$11.26
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.15
Rate for Payer: Elderplan Medicare Advantage	$11.26
Rate for Payer: EmblemHealth Commercial	$11.26
Rate for Payer: Fidelis Essential Plan Aliesa	$9.57
Rate for Payer: Fidelis Essential Plan QHP	$10.02
Rate for Payer: Fidelis Medicare Advantage	$11.26
Rate for Payer: Fidelis Qualified Health Plan	$10.02
Rate for Payer: Group Health Inc Commercial	$11.26
Rate for Payer: Group Health Inc Medicare	$11.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.08
Rate for Payer: Hamaspik Choice Inc Medicare	$11.26
Rate for Payer: Healthfirst Medicare Advantage	$11.26
Rate for Payer: Healthfirst QHP	$11.26
Rate for Payer: Humana Medicare	$11.49
Rate for Payer: Senior Whole Health Medicare Advantage	$11.26
Rate for Payer: United Healthcare Commercial	$14.26
Rate for Payer: United Healthcare Medicare Advantage	$11.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.01
Rate for Payer: Wellcare Medicare	$10.13

HEPATITIS A IGM

Facility

$28.15

Service Code	HCPCS 86709
Hospital Charge Code	40717048
Hospital Revenue Code	302
Rate for Payer: Cash Price	$11.26

HEPATITIS A VACCINE 1440 EL U/ML IM SUSP [91034]

Facility

$99.29

Service Code	HCPCS 90632
Hospital Charge Code	58160082652
Hospital Revenue Code	250
Min. Negotiated Rate	$34.75
Max. Negotiated Rate	$79.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.08
Rate for Payer: Aetna Government	$64.08
Rate for Payer: Brighton Health Commercial	$74.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.52
Rate for Payer: Group Health Inc Commercial	$49.64
Rate for Payer: Group Health Inc Medicare	$34.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.64
Rate for Payer: Hamaspik Choice Inc Medicare	$49.64
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$70.54
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$74.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$74.77
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$74.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$64.54

HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP [91045]

Facility

$90.26

Service Code	NDC 00006409502
Hospital Charge Code	00006409502
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: 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 [91033]

Facility

$90.92

Service Code	NDC 58160082552
Hospital Charge Code	58160082552
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: 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 (HAVRIX) INJ ADULT

Facility

$43.59

Service Code	HCPCS 90632
Hospital Charge Code	41645035
Hospital Revenue Code	636
Min. Negotiated Rate	$21.80
Max. Negotiated Rate	$21.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.80
Rate for Payer: Hamaspik Choice Inc Medicare	$21.80

HEPATITIS A VACCINE (HAVRIX) INJ ADULT

Facility

$43.59

Service Code	HCPCS 90632
Hospital Charge Code	41645035
Hospital Revenue Code	636
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$74.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.08
Rate for Payer: Aetna Government	$64.08
Rate for Payer: Brighton Health Commercial	$26.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.06
Rate for Payer: Group Health Inc Commercial	$21.80
Rate for Payer: Group Health Inc Medicare	$15.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.80
Rate for Payer: Hamaspik Choice Inc Medicare	$21.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.77
Rate for Payer: SOMOS Essential	$74.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.33

HEPATITIS A VACCINE (HAVRIX) INJ ADULT

Facility

$43.59

Service Code	HCPCS 90632
Hospital Charge Code	41655035
Hospital Revenue Code	636
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$74.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.08
Rate for Payer: Aetna Government	$64.08
Rate for Payer: Brighton Health Commercial	$26.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.06
Rate for Payer: Group Health Inc Commercial	$21.80
Rate for Payer: Group Health Inc Medicare	$15.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.80
Rate for Payer: Hamaspik Choice Inc Medicare	$21.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.77
Rate for Payer: SOMOS Essential	$74.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.33

HEPATITIS A VACCINE (HAVRIX) INJ ADULT

Facility

$43.59

Service Code	HCPCS 90632
Hospital Charge Code	41655035
Hospital Revenue Code	636
Min. Negotiated Rate	$21.80
Max. Negotiated Rate	$21.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.80
Rate for Payer: Hamaspik Choice Inc Medicare	$21.80

HEPATITIS A VACCINE (HAVRIX) INJ PEDIATR

Facility

$44.00

Service Code	HCPCS 90633
Hospital Charge Code	41651256
Hospital Revenue Code	250
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$35.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
Rate for Payer: Brighton Health Commercial	$33.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.92
Rate for Payer: Group Health Inc Commercial	$22.00
Rate for Payer: Group Health Inc Medicare	$15.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.60

HEPATITIS A VACCINE (HAVRIX) INJ PEDIATR

Facility

$44.00

Service Code	HCPCS 90633
Hospital Charge Code	41641256
Hospital Revenue Code	250
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$35.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
Rate for Payer: Brighton Health Commercial	$33.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.92
Rate for Payer: Group Health Inc Commercial	$22.00
Rate for Payer: Group Health Inc Medicare	$15.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.60

HEPATITIS A (VFC) 250/0.5ML VIAL

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41659554
Hospital Revenue Code	636
Max. Negotiated Rate	$35.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
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

HEPATITIS A (VFC) 250/0.5ML VIAL

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41649554
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

HEPATITIS A (VFC) 250/0.5ML VIAL

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41649554
Hospital Revenue Code	636
Max. Negotiated Rate	$35.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
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

HEPATITIS A (VFC) 250/0.5ML VIAL

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41659554
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

HEPATITIS A (VFC) 720 EU/0.5ML SY

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41659556
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

HEPATITIS A (VFC) 720 EU/0.5ML SY

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41649556
Hospital Revenue Code	636
Max. Negotiated Rate	$35.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
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

HEPATITIS A (VFC) 720 EU/0.5ML SY

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41659556
Hospital Revenue Code	636
Max. Negotiated Rate	$35.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
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

HEPATITIS A (VFC) 720 EU/0.5ML SY

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41649556
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

HEPATITIS A (VFC) 720 EU/0.5ML VI

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41649555
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

HEPATITIS A (VFC) 720 EU/0.5ML VI

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41649555
Hospital Revenue Code	636
Max. Negotiated Rate	$35.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
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

HEPATITIS A (VFC) EU/0.5ML VIAL

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41659555
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

HEPATITIS A (VFC) EU/0.5ML VIAL

Facility

$0.01

Service Code	HCPCS 90633
Hospital Charge Code	41659555
Hospital Revenue Code	636
Max. Negotiated Rate	$35.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
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

HEPATITIS B CORE AB TOTAL

Facility

$30.13

Service Code	HCPCS 86704
Hospital Charge Code	40718337
Hospital Revenue Code	302
Rate for Payer: Cash Price	$12.05

HEPATITIS B CORE AB TOTAL

Facility

$30.13

Service Code	HCPCS 86704
Hospital Charge Code	40718337
Hospital Revenue Code	302
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$22.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.60
Rate for Payer: Cash Price	$12.05
Rate for Payer: Cash Price	$12.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.20
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.64
Rate for Payer: Wellcare Medicare	$10.84

Know your out-of-pocket cost for care.

All Charges