Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VANCOCIN/1GM

Facility

$65.00

Hospital Charge Code	60634119
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$13.00
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

VANCOCIN/250MG/5ML

Facility

$181.00

Hospital Charge Code	60634123
Hospital Revenue Code	250
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$27.15
Rate for Payer: Qualcare PPO/HMO/WC	$27.15

VANCOCIN/250MG/5ML

Facility

$181.00

Hospital Charge Code	60634123
Hospital Revenue Code	250
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna Commercial	$68.78
Rate for Payer: Aetna Medicare Advantage	$54.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.16
Rate for Payer: Cigna Commercial	$90.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Oxford Commercial	$36.20
Rate for Payer: Qualcare PPO/HMO/WC	$27.15
Rate for Payer: UnitedHealthcare Commercial	$36.20
Rate for Payer: UnitedHealthcare Community & State	$4.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

VANCOCIN/250MG/CAP

Facility

$89.00

Hospital Charge Code	60634120
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

VANCOCIN/250MG/CAP

Facility

$89.00

Hospital Charge Code	60634120
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$17.80
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VANCOCIN/500MG

Facility

$49.00

Hospital Charge Code	60634121
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

VANCOCIN/500MG

Facility

$49.00

Hospital Charge Code	60634122
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

VANCOCIN/500MG

Facility

$49.00

Hospital Charge Code	60634121
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

VANCOCIN/500MG

Facility

$49.00

Hospital Charge Code	60634122
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

VANCOCIN/500MG ADD

Facility

$51.00

Hospital Charge Code	60634816
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

VANCOCIN/500MG ADD

Facility

$51.00

Hospital Charge Code	60634816
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

VANCOMYCIM VL 1GM

Facility

$96.00

Hospital Charge Code	6007066
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

VANCOMYCIM VL 1GM

Facility

$96.00

Hospital Charge Code	6007066
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna Commercial	$36.48
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.80
Rate for Payer: Oxford Commercial	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$19.20
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.54

VANCOMYCIN

Facility

$390.00

Service Code	HCPCS 80202
Hospital Charge Code	3008414
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$36.83
Rate for Payer: Aetna Medicare Advantage	$43.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.88
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.54
Rate for Payer: Clover Medicare Advantage	$12.86
Rate for Payer: EmblemHealth Commercial	$40.62
Rate for Payer: Humana Medicare Advantage	$13.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.54
Rate for Payer: Wellcare Medicare Advantage	$13.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VANCOMYCIN

Facility

$40.20

Service Code	HCPCS J3373
Hospital Charge Code	60627331
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

VANCOMYCIN

Facility

$40.20

Service Code	HCPCS J3373
Hospital Charge Code	60627331
Hospital Revenue Code	636
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$9.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

VANCOMYCIN

Facility

$60.37

Service Code	NDC 409653331
Hospital Charge Code	60627328
Hospital Revenue Code	250
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$9.06
Rate for Payer: Qualcare PPO/HMO/WC	$9.06

VANCOMYCIN

Facility

$60.37

Service Code	NDC 409653331
Hospital Charge Code	60627328
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.18
Rate for Payer: Aetna Commercial	$22.94
Rate for Payer: Aetna Medicare Advantage	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.39
Rate for Payer: Cigna Commercial	$30.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.11
Rate for Payer: Oxford Commercial	$12.07
Rate for Payer: Qualcare PPO/HMO/WC	$9.06
Rate for Payer: UnitedHealthcare Commercial	$12.07
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.60

VANCOMYCIN

Facility

$390.00

Service Code	HCPCS 80202
Hospital Charge Code	3008414
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VANCOMYCIN 1.25GM/250ML

Facility

$1,809.00

Service Code	HCPCS J3373
Hospital Charge Code	606390398
Hospital Revenue Code	636
Min. Negotiated Rate	$271.35
Max. Negotiated Rate	$437.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.78
Rate for Payer: Qualcare PPO/HMO/WC	$271.35

VANCOMYCIN 1.25GM/250ML

Facility

$1,809.00

Service Code	HCPCS J3373
Hospital Charge Code	606390398
Hospital Revenue Code	636
Min. Negotiated Rate	$43.60
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna Commercial	$687.42
Rate for Payer: Aetna Medicare Advantage	$542.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.30
Rate for Payer: Cigna Commercial	$904.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.78
Rate for Payer: Qualcare PPO/HMO/WC	$271.35
Rate for Payer: UnitedHealthcare Community & State	$43.60
Rate for Payer: Wellpoint Medicaid Managed Care	$47.94

VANCOMYCIN 125 MG CAP

Facility

$80.00

Hospital Charge Code	6008684
Hospital Revenue Code	251
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

VANCOMYCIN 125 MG CAP

Facility

$80.00

Hospital Charge Code	6008684
Hospital Revenue Code	251
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

VANCOMYCIN 125MG CAP

Facility

$209.78

Service Code	NDC 47781072902
Hospital Charge Code	606361048
Hospital Revenue Code	250
Min. Negotiated Rate	$31.47
Max. Negotiated Rate	$31.47
Rate for Payer: Qualcare PPO/HMO/WC	$31.47

VANCOMYCIN 125MG CAP

Facility

$209.78

Service Code	NDC 47781072902
Hospital Charge Code	606361048
Hospital Revenue Code	250
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$104.89
Rate for Payer: Aetna Commercial	$79.72
Rate for Payer: Aetna Medicare Advantage	$62.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.49
Rate for Payer: Cigna Commercial	$104.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Oxford Commercial	$41.96
Rate for Payer: Qualcare PPO/HMO/WC	$31.47
Rate for Payer: UnitedHealthcare Commercial	$41.96
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5.56

Know your out-of-pocket cost for care.

All Charges