St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN HCL 1.5 G IV SOLR [164996]

Facility

$28.94

Service Code	HCPCS J3370
Hospital Charge Code	67457082499
Hospital Revenue Code	278
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$14.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.47
Rate for Payer: Hamaspik Choice Inc Medicare	$14.47

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	$14.47
Max. Negotiated Rate	$14.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.47
Rate for Payer: Hamaspik Choice Inc Medicare	$14.47

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

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	$2.84
Max. Negotiated Rate	$30.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$17.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.80
Rate for Payer: EmblemHealth Commercial	$14.61
Rate for Payer: Fidelis Medicare Advantage	$30.69
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.00

VANCOMYCIN HCL 1 G IV SOLR [162638]

Facility

$19.25

Service Code	HCPCS J3370
Hospital Charge Code	67457034001
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$20.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$11.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.07
Rate for Payer: EmblemHealth Commercial	$9.62
Rate for Payer: Fidelis Medicare Advantage	$20.21
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.51

VANCOMYCIN HCL 1 G IV SOLR [162638]

Facility

$19.25

Service Code	HCPCS J3370
Hospital Charge Code	67457034001
Hospital Revenue Code	278
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$9.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.62
Rate for Payer: Hamaspik Choice Inc Medicare	$9.62

VANCOMYCIN HCL 1 G IV SOLR [162638]

Facility

$19.08

Service Code	HCPCS J3370
Hospital Charge Code	63323028420
Hospital Revenue Code	278
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$9.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.54
Rate for Payer: Hamaspik Choice Inc Medicare	$9.54

VANCOMYCIN HCL 1 G IV SOLR [162638]

Facility

$19.08

Service Code	HCPCS J3370
Hospital Charge Code	63323028420
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$20.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$11.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.97
Rate for Payer: EmblemHealth Commercial	$9.54
Rate for Payer: Fidelis Medicare Advantage	$20.03
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.40

VANCOMYCIN HCL 25 MG/ML PO SOLR [160236]

Facility

$0.90

Service Code	NDC 09999123407
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: 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

VANCOMYCIN HCL 500 MG/100ML IV SOLN [170119]

Facility

$0.11

Service Code	HCPCS J3370
Hospital Charge Code	70594004103
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 500 MG/100ML IV SOLN [170119]

Facility

$0.11

Service Code	HCPCS J3370
Hospital Charge Code	70594004103
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$2.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
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	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Fidelis Medicare Advantage	$0.11
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

VANCOMYCIN HCL 500 MG IV SOLR [8443]

Facility

$9.79

Service Code	HCPCS J3370
Hospital Charge Code	00409433201
Hospital Revenue Code	278
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.90
Rate for Payer: Hamaspik Choice Inc Medicare	$4.90

VANCOMYCIN HCL 500 MG IV SOLR [8443]

Facility

$9.79

Service Code	HCPCS J3370
Hospital Charge Code	00409433201
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$10.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$5.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.63
Rate for Payer: EmblemHealth Commercial	$4.90
Rate for Payer: Fidelis Medicare Advantage	$10.28
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.37

VANCOMYCIN HCL 500 MG IV SOLR [8443]

Facility

$8.40

Service Code	HCPCS J3370
Hospital Charge Code	63323022110
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$8.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$5.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.83
Rate for Payer: EmblemHealth Commercial	$4.20
Rate for Payer: Fidelis Medicare Advantage	$8.82
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.46

VANCOMYCIN HCL 500 MG IV SOLR [8443]

Facility

$4.93

Service Code	HCPCS J3370
Hospital Charge Code	70436002082
Hospital Revenue Code	278
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.47
Rate for Payer: Hamaspik Choice Inc Medicare	$2.47

VANCOMYCIN HCL 500 MG IV SOLR [8443]

Facility

$3.60

Service Code	HCPCS J3370
Hospital Charge Code	72611076110
Hospital Revenue Code	278
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$2.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: EmblemHealth Commercial	$1.80
Rate for Payer: Fidelis Medicare Advantage	$3.78
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.34

VANCOMYCIN HCL 500 MG IV SOLR [8443]

Facility

$8.40

Service Code	HCPCS J3370
Hospital Charge Code	63323022110
Hospital Revenue Code	278
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.20
Rate for Payer: Hamaspik Choice Inc Medicare	$4.20

VANCOMYCIN HCL 500 MG IV SOLR [8443]

Facility

$4.93

Service Code	HCPCS J3370
Hospital Charge Code	70436002082
Hospital Revenue Code	278
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$5.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$2.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.84
Rate for Payer: EmblemHealth Commercial	$2.47
Rate for Payer: Fidelis Medicare Advantage	$5.18
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.21

VANCOMYCIN HCL 500 MG IV SOLR [8443]

Facility

$3.60

Service Code	HCPCS J3370
Hospital Charge Code	72611076110
Hospital Revenue Code	278
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80

VANCOMYCIN HCL 5 G IV SOLR [162639]

Facility

$36.00

Service Code	HCPCS J3370
Hospital Charge Code	70594004701
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$37.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$21.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.70
Rate for Payer: EmblemHealth Commercial	$18.00
Rate for Payer: Fidelis Medicare Advantage	$37.80
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.40

VANCOMYCIN HCL 5 G IV SOLR [162639]

Facility

$29.24

Service Code	HCPCS J3370
Hospital Charge Code	63323029566
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$30.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$17.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.81
Rate for Payer: EmblemHealth Commercial	$14.62
Rate for Payer: Fidelis Medicare Advantage	$30.70
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.01

VANCOMYCIN HCL 5 G IV SOLR [162639]

Facility

$36.00

Service Code	HCPCS J3370
Hospital Charge Code	70594004701
Hospital Revenue Code	278
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00

VANCOMYCIN HCL 5 G IV SOLR [162639]

Facility

$59.99

Service Code	HCPCS J3370
Hospital Charge Code	25021015799
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00

VANCOMYCIN HCL 5 G IV SOLR [162639]

Facility

$95.40

Service Code	HCPCS J3370
Hospital Charge Code	63323029561
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$100.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$57.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.86
Rate for Payer: EmblemHealth Commercial	$47.70
Rate for Payer: Fidelis Medicare Advantage	$100.17
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.01

VANCOMYCIN HCL 5 G IV SOLR [162639]

Facility

$95.40

Service Code	HCPCS J3370
Hospital Charge Code	63323029561
Hospital Revenue Code	278
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.70
Rate for Payer: Hamaspik Choice Inc Medicare	$47.70

Know your out-of-pocket cost for care.

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