St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN HCL 10 G IV SOLR

Facility

$255.00

Service Code	HCPCS J3373
Hospital Charge Code	6332331461
Hospital Revenue Code	258
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.50

VANCOMYCIN HCL 10 G IV SOLR

Facility

$255.00

Service Code	HCPCS J3373
Hospital Charge Code	6332331461
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$204.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.50
Rate for Payer: Aetna Government	$127.50
Rate for Payer: Brighton Health Commercial	$191.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.40
Rate for Payer: EmblemHealth Commercial	$127.50
Rate for Payer: Group Health Inc Commercial	$127.50
Rate for Payer: Group Health Inc Medicare	$89.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.50
Rate for Payer: Hamaspik Choice Inc Medicare	$127.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$165.75

VANCOMYCIN HCL 1250 MG/250ML IV SOLN

Facility

$0.09

Service Code	HCPCS J3375
Hospital Charge Code	7059405701
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

VANCOMYCIN HCL 1250 MG/250ML IV SOLN

Facility

$0.09

Service Code	HCPCS J3375
Hospital Charge Code	7059405702
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

VANCOMYCIN HCL 1250 MG/250ML IV SOLN

Facility

$0.09

Service Code	HCPCS J3375
Hospital Charge Code	7059405702
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

VANCOMYCIN HCL 1250 MG/250ML IV SOLN

Facility

$0.09

Service Code	HCPCS J3375
Hospital Charge Code	7059405701
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3374
Hospital Charge Code	5515047110
Hospital Revenue Code	258
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3374
Hospital Charge Code	6745782399
Hospital Revenue Code	258
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3374
Hospital Charge Code	6745782399
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$19.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.06
Rate for Payer: Aetna Government	$12.06
Rate for Payer: Brighton Health Commercial	$18.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.40
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Group Health Inc Commercial	$12.06
Rate for Payer: Group Health Inc Medicare	$8.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.68

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3374
Hospital Charge Code	6745782312
Hospital Revenue Code	258
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3373
Hospital Charge Code	6846247830
Hospital Revenue Code	258
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3374
Hospital Charge Code	6745782312
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$19.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.06
Rate for Payer: Aetna Government	$12.06
Rate for Payer: Brighton Health Commercial	$18.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.40
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Group Health Inc Commercial	$12.06
Rate for Payer: Group Health Inc Medicare	$8.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.68

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3374
Hospital Charge Code	5515047110
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$19.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.06
Rate for Payer: Aetna Government	$12.06
Rate for Payer: Brighton Health Commercial	$18.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.40
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Group Health Inc Commercial	$12.06
Rate for Payer: Group Health Inc Medicare	$8.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.68

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3373
Hospital Charge Code	6846247830
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$19.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.06
Rate for Payer: Aetna Government	$12.06
Rate for Payer: Brighton Health Commercial	$18.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.40
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Group Health Inc Commercial	$12.06
Rate for Payer: Group Health Inc Medicare	$8.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.68

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3373
Hospital Charge Code	5515047101
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$19.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.06
Rate for Payer: Aetna Government	$12.06
Rate for Payer: Brighton Health Commercial	$18.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.40
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Group Health Inc Commercial	$12.06
Rate for Payer: Group Health Inc Medicare	$8.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.68

VANCOMYCIN HCL 1.25 G IV SOLR

Facility

$24.12

Service Code	HCPCS J3373
Hospital Charge Code	5515047101
Hospital Revenue Code	258
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06

VANCOMYCIN HCL 1500 MG/300ML IV SOLN

Facility

$0.09

Service Code	HCPCS J3375
Hospital Charge Code	7059404302
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

VANCOMYCIN HCL 1500 MG/300ML IV SOLN

Facility

$0.09

Service Code	HCPCS J3375
Hospital Charge Code	7059404302
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

VANCOMYCIN HCL 1.5 G IV SOLR

Facility

$28.94

Service Code	HCPCS J3374
Hospital Charge Code	6745782499
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$23.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.47
Rate for Payer: Aetna Government	$14.47
Rate for Payer: Brighton Health Commercial	$21.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.68
Rate for Payer: EmblemHealth Commercial	$14.47
Rate for Payer: Group Health Inc Commercial	$14.47
Rate for Payer: Group Health Inc Medicare	$10.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.47
Rate for Payer: Hamaspik Choice Inc Medicare	$14.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.81

VANCOMYCIN HCL 1.5 G IV SOLR

Facility

$29.22

Service Code	HCPCS J3373
Hospital Charge Code	0409351501
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$23.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.61
Rate for Payer: Aetna Government	$14.61
Rate for Payer: Brighton Health Commercial	$21.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.87
Rate for Payer: EmblemHealth Commercial	$14.61
Rate for Payer: Group Health Inc Commercial	$14.61
Rate for Payer: Group Health Inc Medicare	$10.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.61
Rate for Payer: Hamaspik Choice Inc Medicare	$14.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.00

VANCOMYCIN HCL 1.5 G IV SOLR

Facility

$28.94

Service Code	HCPCS J3374
Hospital Charge Code	6745782499
Hospital Revenue Code	258
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$14.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.47

VANCOMYCIN HCL 1.5 G IV SOLR

Facility

$29.22

Service Code	HCPCS J3373
Hospital Charge Code	0409351501
Hospital Revenue Code	258
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$14.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.61

VANCOMYCIN HCL 1.5 G IV SOLR

Facility

$28.94

Service Code	HCPCS J3374
Hospital Charge Code	6745782415
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$23.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.47
Rate for Payer: Aetna Government	$14.47
Rate for Payer: Brighton Health Commercial	$21.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.68
Rate for Payer: EmblemHealth Commercial	$14.47
Rate for Payer: Group Health Inc Commercial	$14.47
Rate for Payer: Group Health Inc Medicare	$10.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.47
Rate for Payer: Hamaspik Choice Inc Medicare	$14.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.81

VANCOMYCIN HCL 1.5 G IV SOLR

Facility

$28.94

Service Code	HCPCS J3374
Hospital Charge Code	6745782415
Hospital Revenue Code	258
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$14.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.47

VANCOMYCIN HCL 1750 MG/350ML IV SOLN

Facility

$0.09

Service Code	HCPCS J3375
Hospital Charge Code	7059405802
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

Know your out-of-pocket cost for care.

All Charges