CMS Price Transparency Data

Flu vaccine (high dose)

Facility: Hospital for Special Surgery

Billing Code: 90656 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90656
Insurance Median: $20
Cash Discount Price: $35
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Flu vaccine (high dose) at Hospital for Special Surgery is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

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 (%)

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Commercial Insurance Negotiated Rates

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

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$11 - $37	N/A
Metro Plus	$12	N/A
Apwu [1016]	$18 - $21	N/A
Wellfleet [1361]	$18 - $21	N/A
Nalc [1090]	$18 - $21	N/A
Qualcare [1101]	$18 - $21	N/A
Cigna	$18 - $21	N/A
Emblem Health [1043]	$20 - $37	N/A
Connecticare [1039]	$20 - $37	N/A
Nyship	$21	N/A
Horizon	$22	N/A
UnitedHealthcare	$22 - $37	N/A
Webtpa [1356]	$24 - $37	N/A
Aetna	$24 - $39	N/A
Nippon Life [1092]	$24 - $37	N/A
Meritain Health [1085]	$24 - $37	N/A
Christian Brothers [1034]	$24 - $37	N/A
Affinity By Molina Health Plan [1005]	$25 - $37	N/A
Geha [1053]	$37	N/A
Fidelis Essential [1323]	$37	N/A
Harvard Pilgrim [1057]	$37	N/A
Medicare (plans)	$37	N/A
Oxford [1096]	$37	N/A
Student Resources [1103]	$37	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 $35.
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 Hospital for Special Surgery 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.