St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

$59.99

Service Code	HCPCS J3370
Hospital Charge Code	25021015799
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$62.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$35.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.49
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Medicare Advantage	$62.99
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.99

VANCOMYCIN HCL 750 MG/150ML IV SOLN [174637]

Facility

$0.10

Service Code	HCPCS J3370
Hospital Charge Code	70594005603
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 750 MG/150ML IV SOLN [174637]

Facility

$0.10

Service Code	HCPCS J3370
Hospital Charge Code	70594005603
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	$0.06
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 750 MG IV SOLR [97371]

Facility

$11.63

Service Code	HCPCS J3370
Hospital Charge Code	67457070575
Hospital Revenue Code	278
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$5.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.81
Rate for Payer: Hamaspik Choice Inc Medicare	$5.81

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$11.63

Service Code	HCPCS J3370
Hospital Charge Code	67457070575
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$12.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$6.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.69
Rate for Payer: EmblemHealth Commercial	$5.81
Rate for Payer: Fidelis Medicare Advantage	$12.21
Rate for Payer: Group Health Inc Commercial	$5.81
Rate for Payer: Group Health Inc Medicare	$4.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.81
Rate for Payer: Hamaspik Choice Inc Medicare	$5.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.56

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$11.80

Service Code	HCPCS J3370
Hospital Charge Code	00409653102
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$12.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$7.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.79
Rate for Payer: EmblemHealth Commercial	$5.90
Rate for Payer: Fidelis Medicare Advantage	$12.39
Rate for Payer: Group Health Inc Commercial	$5.90
Rate for Payer: Group Health Inc Medicare	$4.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.90
Rate for Payer: Hamaspik Choice Inc Medicare	$5.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.67

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$9.10

Service Code	HCPCS J3370
Hospital Charge Code	63323020326
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$9.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$5.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.23
Rate for Payer: EmblemHealth Commercial	$4.55
Rate for Payer: Fidelis Medicare Advantage	$9.55
Rate for Payer: Group Health Inc Commercial	$4.55
Rate for Payer: Group Health Inc Medicare	$3.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.55
Rate for Payer: Hamaspik Choice Inc Medicare	$4.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.91

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$9.10

Service Code	HCPCS J3370
Hospital Charge Code	63323020326
Hospital Revenue Code	278
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.55
Rate for Payer: Hamaspik Choice Inc Medicare	$4.55

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$9.10

Service Code	HCPCS J3370
Hospital Charge Code	63323020341
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$9.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$5.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.23
Rate for Payer: EmblemHealth Commercial	$4.55
Rate for Payer: Fidelis Medicare Advantage	$9.56
Rate for Payer: Group Health Inc Commercial	$4.55
Rate for Payer: Group Health Inc Medicare	$3.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.55
Rate for Payer: Hamaspik Choice Inc Medicare	$4.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.92

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$11.40

Service Code	HCPCS J3370
Hospital Charge Code	63323020320
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$11.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$6.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.56
Rate for Payer: EmblemHealth Commercial	$5.70
Rate for Payer: Fidelis Medicare Advantage	$11.97
Rate for Payer: Group Health Inc Commercial	$5.70
Rate for Payer: Group Health Inc Medicare	$3.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.70
Rate for Payer: Hamaspik Choice Inc Medicare	$5.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.41

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$11.80

Service Code	HCPCS J3370
Hospital Charge Code	00409653102
Hospital Revenue Code	278
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$5.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.90
Rate for Payer: Hamaspik Choice Inc Medicare	$5.90

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$9.10

Service Code	HCPCS J3370
Hospital Charge Code	63323020341
Hospital Revenue Code	278
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.55
Rate for Payer: Hamaspik Choice Inc Medicare	$4.55

VANCOMYCIN HCL 750 MG IV SOLR [97371]

Facility

$11.40

Service Code	HCPCS J3370
Hospital Charge Code	63323020320
Hospital Revenue Code	278
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.70
Rate for Payer: Hamaspik Choice Inc Medicare	$5.70

VANCOMYCIN OPHTH 50MG/ML

Facility

$11.00

Hospital Charge Code	41646635
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

VANCOMYCIN OPHTH 50MG/ML

Facility

$11.00

Hospital Charge Code	41656635
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

VANCOMYCIN ORAL

Facility

$0.54

Service Code	HCPCS J3370
Hospital Charge Code	41642997
Hospital Revenue Code	636
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$2.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
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	$0.35

VANCOMYCIN ORAL

Facility

$0.54

Service Code	HCPCS J3370
Hospital Charge Code	41642997
Hospital Revenue Code	636
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27

VANCOMYCIN ORAL

Facility

$0.54

Service Code	HCPCS J3370
Hospital Charge Code	41652997
Hospital Revenue Code	636
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27

VANCOMYCIN ORAL

Facility

$0.54

Service Code	HCPCS J3370
Hospital Charge Code	41652997
Hospital Revenue Code	636
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$2.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
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	$0.35

VANCOMYCIN ORAL SOL 125MG/5ML

Facility

$2.00

Hospital Charge Code	41647103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

VANCOMYCIN ORAL SOL 125MG/5ML

Facility

$2.00

Service Code	HCPCS J3370
Hospital Charge Code	41657103
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
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	$1.30

VANCOMYCIN ORAL SOL 125MG/5ML

Facility

$2.00

Service Code	HCPCS J3370
Hospital Charge Code	41657103
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

VANCOMYCIN PEAK

Facility

$33.85

Service Code	HCPCS 80202
Hospital Charge Code	40602600
Hospital Revenue Code	301
Rate for Payer: Cash Price	$13.54

VANCOMYCIN PEAK

Facility

$33.85

Service Code	HCPCS 80202
Hospital Charge Code	40602600
Hospital Revenue Code	301
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$25.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.54
Rate for Payer: Aetna Government	$13.54
Rate for Payer: Brighton Health Commercial	$25.39
Rate for Payer: Cash Price	$13.54
Rate for Payer: Cash Price	$13.54
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.22
Rate for Payer: Elderplan Medicare Advantage	$13.54
Rate for Payer: EmblemHealth Commercial	$13.54
Rate for Payer: Fidelis Essential Plan Aliesa	$11.51
Rate for Payer: Fidelis Essential Plan QHP	$12.05
Rate for Payer: Fidelis Medicare Advantage	$13.54
Rate for Payer: Fidelis Qualified Health Plan	$12.05
Rate for Payer: Group Health Inc Commercial	$13.54
Rate for Payer: Group Health Inc Medicare	$13.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.92
Rate for Payer: Hamaspik Choice Inc Medicare	$13.54
Rate for Payer: Healthfirst Medicare Advantage	$13.54
Rate for Payer: Healthfirst QHP	$13.54
Rate for Payer: Senior Whole Health Medicare Advantage	$13.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.83
Rate for Payer: Wellcare Medicare	$12.19

Know your out-of-pocket cost for care.

All Charges