Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN 500 MG (ORAL USE)

Facility

$64.66

Service Code	NDC 63323022110
Hospital Charge Code	60627329
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$9.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.70

VANCOMYCIN 50 MG/ML 300ML ORAL

Facility

$26.00

Service Code	NDC 65628020810
Hospital Charge Code	606390237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$5.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

VANCOMYCIN 50 MG/ML 300ML ORAL

Facility

$26.00

Service Code	NDC 65628020810
Hospital Charge Code	606390237
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

VANCOMYCIN 750MG (150ML BAG)

Facility

$1,157.76

Service Code	HCPCS J3373
Hospital Charge Code	60630224
Hospital Revenue Code	636
Min. Negotiated Rate	$173.66
Max. Negotiated Rate	$280.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.18
Rate for Payer: Qualcare PPO/HMO/WC	$173.66

VANCOMYCIN 750MG (150ML BAG)

Facility

$1,157.76

Service Code	HCPCS J3373
Hospital Charge Code	60630224
Hospital Revenue Code	636
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$578.88
Rate for Payer: Aetna Commercial	$439.95
Rate for Payer: Aetna Medicare Advantage	$347.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.23
Rate for Payer: Cigna Commercial	$578.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.18
Rate for Payer: Qualcare PPO/HMO/WC	$173.66
Rate for Payer: UnitedHealthcare Community & State	$27.90
Rate for Payer: Wellpoint Medicaid Managed Care	$30.68

VANCOMYCIN 750MG VIAL

Facility

$21.76

Hospital Charge Code	60635773
Hospital Revenue Code	636
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$5.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.26

VANCOMYCIN 750MG VIAL

Facility

$21.76

Hospital Charge Code	60635773
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.88
Rate for Payer: Aetna Commercial	$8.27
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.55
Rate for Payer: Cigna Commercial	$10.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.26
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

VANCOMYCIN 750MG VIAL

Facility

$22.80

Hospital Charge Code	60635742
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.40
Rate for Payer: Aetna Commercial	$8.66
Rate for Payer: Aetna Medicare Advantage	$6.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.81
Rate for Payer: Cigna Commercial	$11.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$3.42
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

VANCOMYCIN 750MG VIAL

Facility

$22.80

Hospital Charge Code	60635742
Hospital Revenue Code	636
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$5.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$3.42

VANCOMYCIN 750MG VIAL (PER 500

Facility

$27.20

Hospital Charge Code	606351014
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.60
Rate for Payer: Aetna Commercial	$10.34
Rate for Payer: Aetna Medicare Advantage	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.94
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.58
Rate for Payer: Qualcare PPO/HMO/WC	$4.08
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

VANCOMYCIN 750MG VIAL (PER 500

Facility

$27.20

Hospital Charge Code	606351014
Hospital Revenue Code	636
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$6.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.58
Rate for Payer: Qualcare PPO/HMO/WC	$4.08

VANCOMYCIN CAP 125MG

Facility

$34.60

Hospital Charge Code	60628863
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

VANCOMYCIN CAP 125MG

Facility

$34.60

Hospital Charge Code	60628863
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

VANCOMYCIN CAP 125MG

Facility

$41.60

Hospital Charge Code	6008676
Hospital Revenue Code	251
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

VANCOMYCIN CAP 125MG

Facility

$41.60

Hospital Charge Code	6008676
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

VANCOMYCIN HCL 1.25GM/VIAL

Facility

$161.60

Service Code	HCPCS J3373
Hospital Charge Code	606390318
Hospital Revenue Code	636
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$80.80
Rate for Payer: Aetna Commercial	$61.41
Rate for Payer: Aetna Medicare Advantage	$48.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.21
Rate for Payer: Cigna Commercial	$80.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.11
Rate for Payer: Qualcare PPO/HMO/WC	$24.24
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: Wellpoint Medicaid Managed Care	$4.28

VANCOMYCIN HCL 1.25GM/VIAL

Facility

$161.60

Service Code	HCPCS J3373
Hospital Charge Code	606390318
Hospital Revenue Code	636
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$39.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.11
Rate for Payer: Qualcare PPO/HMO/WC	$24.24

VANCOMYCIN INJ 500MG

Facility

$61.45

Hospital Charge Code	600559
Hospital Revenue Code	250
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

VANCOMYCIN INJ 500MG

Facility

$61.45

Hospital Charge Code	600559
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$23.35
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.43
Rate for Payer: Oxford Commercial	$12.29
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$12.29
Rate for Payer: UnitedHealthcare Community & State	$1.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

VANCOMYCIN INJ 500MG

Facility

$52.50

Hospital Charge Code	6005599
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

VANCOMYCIN INJ 500MG

Facility

$52.50

Hospital Charge Code	6005599
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

VANCOMYCIN IVPB 500MG/NS 100ML

Facility

$54.85

Hospital Charge Code	60627330
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.43
Rate for Payer: Aetna Commercial	$20.84
Rate for Payer: Aetna Medicare Advantage	$16.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.99
Rate for Payer: Cigna Commercial	$27.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.45
Rate for Payer: Oxford Commercial	$10.97
Rate for Payer: Qualcare PPO/HMO/WC	$8.23
Rate for Payer: UnitedHealthcare Commercial	$10.97
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

VANCOMYCIN IVPB 500MG/NS 100ML

Facility

$54.85

Hospital Charge Code	60627330
Hospital Revenue Code	250
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.23

VANCOMYCIN IVPB 750MG/D5W 250M

Facility

$97.15

Service Code	NDC 409653101
Hospital Charge Code	60627333
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.58
Rate for Payer: Aetna Commercial	$36.92
Rate for Payer: Aetna Medicare Advantage	$29.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.77
Rate for Payer: Cigna Commercial	$48.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.14
Rate for Payer: Oxford Commercial	$19.43
Rate for Payer: Qualcare PPO/HMO/WC	$14.57
Rate for Payer: UnitedHealthcare Commercial	$19.43
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

VANCOMYCIN IVPB 750MG/D5W 250M

Facility

$97.15

Service Code	NDC 409653101
Hospital Charge Code	60627333
Hospital Revenue Code	250
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$14.57

Know your out-of-pocket cost for care.

All Charges