St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN 5 MG/ML INJ PEDIATRICS

Facility

$1.00

Service Code	HCPCS J3370
Hospital Charge Code	41644138
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

VANCOMYCIN 5 MG/ML INJ PEDIATRICS

Facility

$1.00

Service Code	HCPCS J3370
Hospital Charge Code	41654138
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

VANCOMYCIN 5% OPHTHALMIC DROPS - COMPOUNDED [701506]

Facility

$10.98

Service Code	NDC 09999701506
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.49
Rate for Payer: Aetna Government	$5.49
Rate for Payer: Brighton Health Commercial	$8.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.47
Rate for Payer: Group Health Inc Commercial	$5.49
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.49
Rate for Payer: Hamaspik Choice Inc Medicare	$5.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.14

VANCOMYCIN 750 MG/D5W 250 ML PREMIX

Facility

$17.90

Hospital Charge Code	41644659
Hospital Revenue Code	636
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$11.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.95
Rate for Payer: Aetna Government	$8.95
Rate for Payer: Brighton Health Commercial	$10.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.29
Rate for Payer: Group Health Inc Commercial	$8.95
Rate for Payer: Group Health Inc Medicare	$6.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.95
Rate for Payer: Hamaspik Choice Inc Medicare	$8.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.64

VANCOMYCIN 750 MG/D5W 250 ML PREMIX

Facility

$17.90

Hospital Charge Code	41654659
Hospital Revenue Code	636
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$11.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.95
Rate for Payer: Aetna Government	$8.95
Rate for Payer: Brighton Health Commercial	$10.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.29
Rate for Payer: Group Health Inc Commercial	$8.95
Rate for Payer: Group Health Inc Medicare	$6.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.95
Rate for Payer: Hamaspik Choice Inc Medicare	$8.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.64

VANCOMYCIN 750 MG/D5W 250 ML PREMIX

Facility

$17.90

Hospital Charge Code	41644659
Hospital Revenue Code	636
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$8.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.95
Rate for Payer: Hamaspik Choice Inc Medicare	$8.95

VANCOMYCIN 750 MG/D5W 250 ML PREMIX

Facility

$17.90

Hospital Charge Code	41654659
Hospital Revenue Code	636
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$8.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.95
Rate for Payer: Hamaspik Choice Inc Medicare	$8.95

VANCOMYCIN 750 MG INJ

Facility

$4.31

Service Code	HCPCS J3370
Hospital Charge Code	41645202
Hospital Revenue Code	636
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16

VANCOMYCIN 750 MG INJ

Facility

$4.31

Service Code	HCPCS J3370
Hospital Charge Code	41645202
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$2.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$2.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: Group Health Inc Commercial	$2.16
Rate for Payer: Group Health Inc Medicare	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.80

VANCOMYCIN 750 MG INJ

Facility

$4.31

Service Code	HCPCS J3370
Hospital Charge Code	41655202
Hospital Revenue Code	636
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16

VANCOMYCIN 750 MG INJ

Facility

$4.31

Service Code	HCPCS J3370
Hospital Charge Code	41655202
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$2.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$2.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: Group Health Inc Commercial	$2.16
Rate for Payer: Group Health Inc Medicare	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.80

VANCOMYCIN FLUSH 5 MG/ML INJ

Facility

$6.00

Hospital Charge Code	41644137
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

VANCOMYCIN FLUSH 5 MG/ML INJ

Facility

$6.00

Hospital Charge Code	41654137
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

VANCOMYCIN HCL 10 G IV SOLR [11627]

Facility

$255.00

Service Code	HCPCS J3370
Hospital Charge Code	63323031461
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$267.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$153.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.62
Rate for Payer: EmblemHealth Commercial	$127.50
Rate for Payer: Fidelis Medicare Advantage	$267.75
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$165.75

VANCOMYCIN HCL 10 G IV SOLR [11627]

Facility

$255.00

Service Code	HCPCS J3370
Hospital Charge Code	63323031461
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.50
Rate for Payer: Hamaspik Choice Inc Medicare	$127.50

VANCOMYCIN HCL 1250 MG/250ML IV SOLN [174638]

Facility

$0.09

Service Code	HCPCS J3370
Hospital Charge Code	70594005702
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Fidelis Medicare Advantage	$0.10
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

VANCOMYCIN HCL 1250 MG/250ML IV SOLN [174638]

Facility

$0.09

Service Code	HCPCS J3370
Hospital Charge Code	70594005702
Hospital Revenue Code	278
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05

VANCOMYCIN HCL 1.25 G IV SOLR [166312]

Facility

$24.12

Service Code	HCPCS J3370
Hospital Charge Code	67457082399
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$25.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$14.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.87
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Fidelis Medicare Advantage	$25.33
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.68

VANCOMYCIN HCL 1.25 G IV SOLR [166312]

Facility

$24.12

Service Code	HCPCS J3370
Hospital Charge Code	67457082312
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$25.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$14.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.87
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Fidelis Medicare Advantage	$25.33
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.68

VANCOMYCIN HCL 1.25 G IV SOLR [166312]

Facility

$24.12

Service Code	HCPCS J3370
Hospital Charge Code	67457082312
Hospital Revenue Code	278
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.06

VANCOMYCIN HCL 1.25 G IV SOLR [166312]

Facility

$24.12

Service Code	HCPCS J3370
Hospital Charge Code	67457082399
Hospital Revenue Code	278
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.06

VANCOMYCIN HCL 1500 MG/300ML IV SOLN [166612]

Facility

$0.09

Service Code	HCPCS J3370
Hospital Charge Code	70594004302
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Fidelis Medicare Advantage	$0.10
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

VANCOMYCIN HCL 1500 MG/300ML IV SOLN [166612]

Facility

$0.09

Service Code	HCPCS J3370
Hospital Charge Code	70594004302
Hospital Revenue Code	278
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05

VANCOMYCIN HCL 1.5 G IV SOLR [164996]

Facility

$28.94

Service Code	HCPCS J3370
Hospital Charge Code	67457082415
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$30.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$17.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.64
Rate for Payer: EmblemHealth Commercial	$14.47
Rate for Payer: Fidelis Medicare Advantage	$30.39
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.81

VANCOMYCIN HCL 1.5 G IV SOLR [164996]

Facility

$29.22

Service Code	HCPCS J3370
Hospital Charge Code	00409351501
Hospital Revenue Code	278
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$14.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.61
Rate for Payer: Hamaspik Choice Inc Medicare	$14.61

Know your out-of-pocket cost for care.

All Charges