Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN 1.5GM/300ML IVPB

Facility

$127.30

Service Code	HCPCS J3373
Hospital Charge Code	606390516
Hospital Revenue Code	636
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$63.65
Rate for Payer: Aetna Commercial	$48.37
Rate for Payer: Aetna Medicare Advantage	$38.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.46
Rate for Payer: Cigna Commercial	$63.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.81
Rate for Payer: Qualcare PPO/HMO/WC	$19.09
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

VANCOMYCIN 1.5GM/300ML IVPB

Facility

$127.30

Service Code	HCPCS J3373
Hospital Charge Code	606390516
Hospital Revenue Code	636
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$30.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.81
Rate for Payer: Qualcare PPO/HMO/WC	$19.09

VANCOMYCIN 1.5GM VIAL

Facility

$193.90

Service Code	NDC 143915310
Hospital Charge Code	6063943394
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$96.95
Rate for Payer: Aetna Commercial	$73.68
Rate for Payer: Aetna Medicare Advantage	$58.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.44
Rate for Payer: Cigna Commercial	$96.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.17
Rate for Payer: Oxford Commercial	$38.78
Rate for Payer: Qualcare PPO/HMO/WC	$29.09
Rate for Payer: UnitedHealthcare Commercial	$38.78
Rate for Payer: UnitedHealthcare Community & State	$4.67
Rate for Payer: Wellpoint Medicaid Managed Care	$5.14

VANCOMYCIN 1.5GM VIAL

Facility

$193.90

Service Code	NDC 143915310
Hospital Charge Code	6063943394
Hospital Revenue Code	250
Min. Negotiated Rate	$29.09
Max. Negotiated Rate	$29.09
Rate for Payer: Qualcare PPO/HMO/WC	$29.09

VANCOMYCIN 1.75MG/350ML

Facility

$31.20

Service Code	HCPCS J3373
Hospital Charge Code	60639604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.60
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: Aetna Medicare Advantage	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.96
Rate for Payer: Cigna Commercial	$15.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$4.68
Rate for Payer: UnitedHealthcare Commercial	$6.24
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

VANCOMYCIN 1.75MG/350ML

Facility

$31.20

Service Code	HCPCS J3373
Hospital Charge Code	60639604
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$4.68
Rate for Payer: Qualcare PPO/HMO/WC	$4.68

VANCOMYCIN 1.75MG VIALS

Facility

$301.10

Service Code	NDC 72078006599
Hospital Charge Code	606494030
Hospital Revenue Code	250
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$150.55
Rate for Payer: Aetna Commercial	$114.42
Rate for Payer: Aetna Medicare Advantage	$90.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.78
Rate for Payer: Cigna Commercial	$150.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.33
Rate for Payer: Oxford Commercial	$60.22
Rate for Payer: Qualcare PPO/HMO/WC	$45.16
Rate for Payer: UnitedHealthcare Commercial	$60.22
Rate for Payer: UnitedHealthcare Community & State	$7.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

VANCOMYCIN 1.75MG VIALS

Facility

$301.10

Service Code	NDC 72078006599
Hospital Charge Code	606494030
Hospital Revenue Code	250
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$45.16
Rate for Payer: Qualcare PPO/HMO/WC	$45.16

VANCOMYCIN/1GM

Facility

$227.00

Hospital Charge Code	60634125
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$113.50
Rate for Payer: Aetna Commercial	$86.26
Rate for Payer: Aetna Medicare Advantage	$68.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.88
Rate for Payer: Cigna Commercial	$113.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.10
Rate for Payer: Oxford Commercial	$45.40
Rate for Payer: Qualcare PPO/HMO/WC	$34.05
Rate for Payer: UnitedHealthcare Commercial	$45.40
Rate for Payer: UnitedHealthcare Community & State	$5.47
Rate for Payer: Wellpoint Medicaid Managed Care	$6.02

VANCOMYCIN/1GM

Facility

$258.00

Hospital Charge Code	60634124
Hospital Revenue Code	250
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

VANCOMYCIN/1GM

Facility

$227.00

Hospital Charge Code	60634125
Hospital Revenue Code	250
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$34.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.05

VANCOMYCIN/1GM

Facility

$258.00

Hospital Charge Code	60634124
Hospital Revenue Code	250
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$98.04
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.40
Rate for Payer: Oxford Commercial	$51.60
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$51.60
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

VANCOMYCIN, 250MG

Facility

$21.00

Hospital Charge Code	60635463
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

VANCOMYCIN, 250MG

Facility

$21.00

Hospital Charge Code	60635463
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

VANCOMYCIN 250MG CAP

Facility

$386.72

Service Code	NDC 47781073002
Hospital Charge Code	606361049
Hospital Revenue Code	250
Min. Negotiated Rate	$58.01
Max. Negotiated Rate	$58.01
Rate for Payer: Qualcare PPO/HMO/WC	$58.01

VANCOMYCIN 250MG CAP

Facility

$386.72

Service Code	NDC 47781073002
Hospital Charge Code	606361049
Hospital Revenue Code	250
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$193.36
Rate for Payer: Aetna Commercial	$146.95
Rate for Payer: Aetna Medicare Advantage	$116.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.61
Rate for Payer: Cigna Commercial	$193.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.02
Rate for Payer: Oxford Commercial	$77.34
Rate for Payer: Qualcare PPO/HMO/WC	$58.01
Rate for Payer: UnitedHealthcare Commercial	$77.34
Rate for Payer: UnitedHealthcare Community & State	$9.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.25

VANCOMYCIN 2 GM/400ML BAG

Facility

$33.00

Service Code	HCPCS J3373
Hospital Charge Code	606390600
Hospital Revenue Code	636
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

VANCOMYCIN 2 GM/400ML BAG

Facility

$33.00

Service Code	HCPCS J3373
Hospital Charge Code	606390600
Hospital Revenue Code	636
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

VANCOMYCIN 2MG VIALS

Facility

$344.11

Service Code	NDC 72078006699
Hospital Charge Code	60649031
Hospital Revenue Code	636
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$83.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.27
Rate for Payer: Qualcare PPO/HMO/WC	$51.62

VANCOMYCIN 2MG VIALS

Facility

$344.11

Service Code	NDC 72078006699
Hospital Charge Code	60649031
Hospital Revenue Code	636
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$172.06
Rate for Payer: Aetna Commercial	$130.76
Rate for Payer: Aetna Medicare Advantage	$103.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.75
Rate for Payer: Cigna Commercial	$172.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.27
Rate for Payer: Qualcare PPO/HMO/WC	$51.62
Rate for Payer: UnitedHealthcare Community & State	$8.29
Rate for Payer: Wellpoint Medicaid Managed Care	$9.12

VANCOMYCIN/500MG

Facility

$107.00

Hospital Charge Code	60634126
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

VANCOMYCIN/500MG

Facility

$107.00

Hospital Charge Code	60634126
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

VANCOMYCIN 500MG/100ML IVPB

Facility

$72.03

Service Code	HCPCS J3373
Hospital Charge Code	606390500
Hospital Revenue Code	636
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.02
Rate for Payer: Aetna Commercial	$27.37
Rate for Payer: Aetna Medicare Advantage	$21.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.37
Rate for Payer: Cigna Commercial	$36.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

VANCOMYCIN 500MG/100ML IVPB

Facility

$72.03

Service Code	HCPCS J3373
Hospital Charge Code	606390500
Hospital Revenue Code	636
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$17.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

VANCOMYCIN 500 MG (ORAL USE)

Facility

$64.66

Service Code	NDC 63323022110
Hospital Charge Code	60627329
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$32.33
Rate for Payer: Aetna Commercial	$24.57
Rate for Payer: Aetna Medicare Advantage	$19.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.49
Rate for Payer: Cigna Commercial	$32.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.40
Rate for Payer: Oxford Commercial	$12.93
Rate for Payer: Qualcare PPO/HMO/WC	$9.70
Rate for Payer: UnitedHealthcare Commercial	$12.93
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.71

Know your out-of-pocket cost for care.

All Charges