St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

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	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

VANCOMYCIN HCL 1750 MG/350ML IV SOLN

Facility

$0.09

Service Code	HCPCS J3375
Hospital Charge Code	7059405801
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

VANCOMYCIN HCL 1.75 G IV SOLR

Facility

$44.94

Service Code	HCPCS J3374
Hospital Charge Code	7207806550
Hospital Revenue Code	258
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$22.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.47

VANCOMYCIN HCL 1.75 G IV SOLR

Facility

$44.94

Service Code	HCPCS J3374
Hospital Charge Code	7207806599
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$35.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.47
Rate for Payer: Aetna Government	$22.47
Rate for Payer: Brighton Health Commercial	$33.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.56
Rate for Payer: EmblemHealth Commercial	$22.47
Rate for Payer: Group Health Inc Commercial	$22.47
Rate for Payer: Group Health Inc Medicare	$15.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.47
Rate for Payer: Hamaspik Choice Inc Medicare	$22.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.21

VANCOMYCIN HCL 1.75 G IV SOLR

Facility

$44.94

Service Code	HCPCS J3374
Hospital Charge Code	7207806550
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$35.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.47
Rate for Payer: Aetna Government	$22.47
Rate for Payer: Brighton Health Commercial	$33.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.56
Rate for Payer: EmblemHealth Commercial	$22.47
Rate for Payer: Group Health Inc Commercial	$22.47
Rate for Payer: Group Health Inc Medicare	$15.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.47
Rate for Payer: Hamaspik Choice Inc Medicare	$22.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.21

VANCOMYCIN HCL 1.75 G IV SOLR

Facility

$44.94

Service Code	HCPCS J3374
Hospital Charge Code	7207806599
Hospital Revenue Code	258
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$22.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.47

VANCOMYCIN HCL 1 G IV SOLR

Facility

$19.25

Service Code	HCPCS J3373
Hospital Charge Code	6745734000
Hospital Revenue Code	258
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$9.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.62

VANCOMYCIN HCL 1 G IV SOLR

Facility

$7.20

Service Code	HCPCS J3373
Hospital Charge Code	7128802320
Hospital Revenue Code	258
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60

VANCOMYCIN HCL 1 G IV SOLR

Facility

$19.25

Service Code	HCPCS J3373
Hospital Charge Code	6745734001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$15.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.62
Rate for Payer: Aetna Government	$9.62
Rate for Payer: Brighton Health Commercial	$14.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.09
Rate for Payer: EmblemHealth Commercial	$9.62
Rate for Payer: Group Health Inc Commercial	$9.62
Rate for Payer: Group Health Inc Medicare	$6.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.62
Rate for Payer: Hamaspik Choice Inc Medicare	$9.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.51

VANCOMYCIN HCL 1 G IV SOLR

Facility

$7.20

Service Code	HCPCS J3373
Hospital Charge Code	7128802320
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$5.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.60
Rate for Payer: Aetna Government	$3.60
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.90
Rate for Payer: EmblemHealth Commercial	$3.60
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

VANCOMYCIN HCL 1 G IV SOLR

Facility

$6.03

Service Code	HCPCS J3373
Hospital Charge Code	7043602182
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$4.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: EmblemHealth Commercial	$3.02
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.92

VANCOMYCIN HCL 1 G IV SOLR

Facility

$19.25

Service Code	HCPCS J3373
Hospital Charge Code	6745734000
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$15.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.62
Rate for Payer: Aetna Government	$9.62
Rate for Payer: Brighton Health Commercial	$14.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.09
Rate for Payer: EmblemHealth Commercial	$9.62
Rate for Payer: Group Health Inc Commercial	$9.62
Rate for Payer: Group Health Inc Medicare	$6.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.62
Rate for Payer: Hamaspik Choice Inc Medicare	$9.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.51

VANCOMYCIN HCL 1 G IV SOLR

Facility

$19.08

Service Code	HCPCS J3373
Hospital Charge Code	6332328401
Hospital Revenue Code	258
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$9.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.54

VANCOMYCIN HCL 1 G IV SOLR

Facility

$19.08

Service Code	HCPCS J3373
Hospital Charge Code	6332328420
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$15.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.54
Rate for Payer: Aetna Government	$9.54
Rate for Payer: Brighton Health Commercial	$14.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.97
Rate for Payer: EmblemHealth Commercial	$9.54
Rate for Payer: Group Health Inc Commercial	$9.54
Rate for Payer: Group Health Inc Medicare	$6.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.54
Rate for Payer: Hamaspik Choice Inc Medicare	$9.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.40

VANCOMYCIN HCL 1 G IV SOLR

Facility

$19.08

Service Code	HCPCS J3373
Hospital Charge Code	6332328420
Hospital Revenue Code	258
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$9.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.54

VANCOMYCIN HCL 1 G IV SOLR

Facility

$6.03

Service Code	HCPCS J3373
Hospital Charge Code	7043602182
Hospital Revenue Code	258
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02

VANCOMYCIN HCL 1 G IV SOLR

Facility

$7.20

Service Code	HCPCS J3373
Hospital Charge Code	0143916201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$5.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.60
Rate for Payer: Aetna Government	$3.60
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.90
Rate for Payer: EmblemHealth Commercial	$3.60
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

VANCOMYCIN HCL 1 G IV SOLR

Facility

$7.20

Service Code	HCPCS J3373
Hospital Charge Code	0143916201
Hospital Revenue Code	258
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60

VANCOMYCIN HCL 1 G IV SOLR

Facility

$19.25

Service Code	HCPCS J3373
Hospital Charge Code	6745734001
Hospital Revenue Code	258
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$9.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.62

VANCOMYCIN HCL 1 G IV SOLR

Facility

$19.08

Service Code	HCPCS J3373
Hospital Charge Code	6332328401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$15.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.54
Rate for Payer: Aetna Government	$9.54
Rate for Payer: Brighton Health Commercial	$14.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.97
Rate for Payer: EmblemHealth Commercial	$9.54
Rate for Payer: Group Health Inc Commercial	$9.54
Rate for Payer: Group Health Inc Medicare	$6.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.54
Rate for Payer: Hamaspik Choice Inc Medicare	$9.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.40

VANCOMYCIN HCL 2000 MG/400ML IV SOLN

Facility

$0.08

Service Code	HCPCS J3375
Hospital Charge Code	7059404402
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

VANCOMYCIN HCL 2000 MG/400ML IV SOLN

Facility

$0.08

Service Code	HCPCS J3375
Hospital Charge Code	7059404402
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	$0.06
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	$0.05

VANCOMYCIN HCL 25 MG/ML PO SOLR

Facility

$0.90

Service Code	NDC 9999123407
Hospital Charge Code	9999123407
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

VANCOMYCIN HCL 25 MG/ML PO SOLR

Facility

$0.90

Service Code	NDC 9999123407
Hospital Charge Code	9999123407
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

Know your out-of-pocket cost for care.

All Charges