CMS Price Transparency Data

Flu vaccine (high dose)

Facility: Good Samaritan Hospital of Suffern

Billing Code: 90656 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90656
Insurance Median: $24
Cash Discount Price: $78
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Flu vaccine (high dose) at Good Samaritan Hospital of Suffern is $24. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$24

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Affinity By Molina McR	$1	N/A
Hamaspik (McR)	$1	N/A
Beacon Commercial	$1 - $2	N/A
Beacon Exchange	$1 - $2	N/A
Mvp Gold (McR)	$1	N/A
Medicare (plans)	$1 - $30	N/A
Geisinger Health Commercial/Exchange	$4	N/A
Oxford Commercial	$21 - $26	N/A
Aetna	$21 - $26	N/A
Mvp Hmo/Ppo	$21 - $26	N/A
Cigna	$21 - $26	N/A
Emblem Ghi/Hip Hmo/Epo/Pos	$21 - $26	N/A
UnitedHealthcare	$21 - $26	N/A
Self-Pay	$21 - $26	N/A
Mvp Exchange	$21 - $26	N/A
Oxford Exchange	$21 - $26	N/A
Self-Pay - Cc 30%	$21 - $26	N/A
Magnacare Standard	$21 - $26	N/A
Emblem Ghi/Hip PPO	$21 - $26	N/A
Blue Cross Blue Shield	$21 - $26	N/A
Emblem Select Care (Exchange)	$21 - $26	N/A
Tricare	$23	N/A
Self-Pay - Cc 50%	$36 - $44	N/A
Cdphp	$36 - $44	N/A
PHCS	$50 - $61	N/A
First Health	$53 - $65	N/A
Multiplan	$53 - $65	N/A
Magnacare Preferred	$64 - $78	N/A

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $78.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: 90656.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Good Samaritan Hospital of Suffern is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code 90656.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.