St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN HCL 500 MG/100ML IV SOLN

Facility

$0.11

Service Code	HCPCS J3375
Hospital Charge Code	7059404101
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 500 MG/100ML IV SOLN

Facility

$0.11

Service Code	HCPCS J3375
Hospital Charge Code	7059404101
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
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	$0.07

VANCOMYCIN HCL 500 MG/100ML IV SOLN

Facility

$0.11

Service Code	HCPCS J3375
Hospital Charge Code	7059404103
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 500 MG/100ML IV SOLN

Facility

$0.11

Service Code	HCPCS J3375
Hospital Charge Code	7059404103
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
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	$0.07

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$9.65

Service Code	HCPCS J3373
Hospital Charge Code	6745733900
Hospital Revenue Code	258
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$4.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.83

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$9.79

Service Code	HCPCS J3373
Hospital Charge Code	0409433211
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$7.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.89
Rate for Payer: Aetna Government	$4.89
Rate for Payer: Brighton Health Commercial	$7.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.66
Rate for Payer: EmblemHealth Commercial	$4.89
Rate for Payer: Group Health Inc Commercial	$4.89
Rate for Payer: Group Health Inc Medicare	$3.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.89
Rate for Payer: Hamaspik Choice Inc Medicare	$4.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.36

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$3.60

Service Code	HCPCS J3373
Hospital Charge Code	7261176110
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.80
Rate for Payer: Aetna Government	$1.80
Rate for Payer: Brighton Health Commercial	$2.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: EmblemHealth Commercial	$1.80
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.34

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$8.40

Service Code	HCPCS J3373
Hospital Charge Code	6332322110
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$6.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.20
Rate for Payer: Aetna Government	$4.20
Rate for Payer: Brighton Health Commercial	$6.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.71
Rate for Payer: EmblemHealth Commercial	$4.20
Rate for Payer: Group Health Inc Commercial	$4.20
Rate for Payer: Group Health Inc Medicare	$2.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.20
Rate for Payer: Hamaspik Choice Inc Medicare	$4.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.46

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$4.93

Service Code	HCPCS J3373
Hospital Charge Code	7043602082
Hospital Revenue Code	258
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.47

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$9.65

Service Code	HCPCS J3373
Hospital Charge Code	6745733900
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$7.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.83
Rate for Payer: Aetna Government	$4.83
Rate for Payer: Brighton Health Commercial	$7.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.56
Rate for Payer: EmblemHealth Commercial	$4.83
Rate for Payer: Group Health Inc Commercial	$4.83
Rate for Payer: Group Health Inc Medicare	$3.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.83
Rate for Payer: Hamaspik Choice Inc Medicare	$4.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.27

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$4.93

Service Code	HCPCS J3373
Hospital Charge Code	7043602082
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$3.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.47
Rate for Payer: Aetna Government	$2.47
Rate for Payer: Brighton Health Commercial	$3.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.35
Rate for Payer: EmblemHealth Commercial	$2.47
Rate for Payer: Group Health Inc Commercial	$2.47
Rate for Payer: Group Health Inc Medicare	$1.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.47
Rate for Payer: Hamaspik Choice Inc Medicare	$2.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.21

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$9.79

Service Code	HCPCS J3373
Hospital Charge Code	0409433211
Hospital Revenue Code	258
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$4.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.89

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$8.40

Service Code	HCPCS J3373
Hospital Charge Code	6332322110
Hospital Revenue Code	258
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.20

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$9.79

Service Code	HCPCS J3373
Hospital Charge Code	0409433201
Hospital Revenue Code	258
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.90

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$3.60

Service Code	HCPCS J3373
Hospital Charge Code	7261176110
Hospital Revenue Code	258
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80

VANCOMYCIN HCL 500 MG IV SOLR

Facility

$9.79

Service Code	HCPCS J3373
Hospital Charge Code	0409433201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$7.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.90
Rate for Payer: Aetna Government	$4.90
Rate for Payer: Brighton Health Commercial	$7.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.66
Rate for Payer: EmblemHealth Commercial	$4.90
Rate for Payer: Group Health Inc Commercial	$4.90
Rate for Payer: Group Health Inc Medicare	$3.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.90
Rate for Payer: Hamaspik Choice Inc Medicare	$4.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.37

VANCOMYCIN HCL 5 G IV SOLR

Facility

$29.24

Service Code	HCPCS J3373
Hospital Charge Code	6332329566
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$23.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.62
Rate for Payer: Aetna Government	$14.62
Rate for Payer: Brighton Health Commercial	$21.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.88
Rate for Payer: EmblemHealth Commercial	$14.62
Rate for Payer: Group Health Inc Commercial	$14.62
Rate for Payer: Group Health Inc Medicare	$10.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.62
Rate for Payer: Hamaspik Choice Inc Medicare	$14.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.01

VANCOMYCIN HCL 5 G IV SOLR

Facility

$59.99

Service Code	HCPCS J3373
Hospital Charge Code	2502115799
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$47.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Brighton Health Commercial	$44.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.79
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.99

VANCOMYCIN HCL 5 G IV SOLR

Facility

$29.24

Service Code	HCPCS J3373
Hospital Charge Code	6332329566
Hospital Revenue Code	258
Min. Negotiated Rate	$14.62
Max. Negotiated Rate	$14.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.62

VANCOMYCIN HCL 5 G IV SOLR

Facility

$95.40

Service Code	HCPCS J3373
Hospital Charge Code	6332329561
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$76.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.70
Rate for Payer: Aetna Government	$47.70
Rate for Payer: Brighton Health Commercial	$71.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.87
Rate for Payer: EmblemHealth Commercial	$47.70
Rate for Payer: Group Health Inc Commercial	$47.70
Rate for Payer: Group Health Inc Medicare	$33.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.70
Rate for Payer: Hamaspik Choice Inc Medicare	$47.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.01

VANCOMYCIN HCL 5 G IV SOLR

Facility

$36.00

Service Code	HCPCS J3373
Hospital Charge Code	7059404701
Hospital Revenue Code	258
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00

VANCOMYCIN HCL 5 G IV SOLR

Facility

$95.40

Service Code	HCPCS J3373
Hospital Charge Code	6332329561
Hospital Revenue Code	258
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.70

VANCOMYCIN HCL 5 G IV SOLR

Facility

$36.00

Service Code	HCPCS J3373
Hospital Charge Code	7059404701
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$28.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.00
Rate for Payer: Aetna Government	$18.00
Rate for Payer: Brighton Health Commercial	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.48
Rate for Payer: EmblemHealth Commercial	$18.00
Rate for Payer: Group Health Inc Commercial	$18.00
Rate for Payer: Group Health Inc Medicare	$12.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.40

VANCOMYCIN HCL 5 G IV SOLR

Facility

$59.99

Service Code	HCPCS J3373
Hospital Charge Code	2502115799
Hospital Revenue Code	258
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00

VANCOMYCIN HCL 750 MG/150ML IV SOLN

Facility

$0.10

Service Code	HCPCS J3375
Hospital Charge Code	7059405601
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

Know your out-of-pocket cost for care.

All Charges