Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN IVPB 750MG/NS 250ML

Facility

$96.00

Hospital Charge Code	60627332
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

VANCOMYCIN IVPB 750MG/NS 250ML

Facility

$96.00

Hospital Charge Code	60627332
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 LQ 1GM

Facility

$317.45

Hospital Charge Code	6005607
Hospital Revenue Code	252
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$158.72
Rate for Payer: Aetna Commercial	$120.63
Rate for Payer: Aetna Medicare Advantage	$95.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.95
Rate for Payer: Cigna Commercial	$158.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.23
Rate for Payer: Oxford Commercial	$63.49
Rate for Payer: Qualcare PPO/HMO/WC	$47.62
Rate for Payer: UnitedHealthcare Commercial	$63.49
Rate for Payer: UnitedHealthcare Community & State	$7.65
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

VANCOMYCIN LQ 1GM

Facility

$317.45

Hospital Charge Code	6005607
Hospital Revenue Code	252
Min. Negotiated Rate	$47.62
Max. Negotiated Rate	$47.62
Rate for Payer: Qualcare PPO/HMO/WC	$47.62

VANCOMYCIN PEAK

Facility

$174.00

Service Code	HCPCS 80202
Hospital Charge Code	38479045
Hospital Revenue Code	301
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

VANCOMYCIN PEAK

Facility

$174.00

Service Code	HCPCS 80202
Hospital Charge Code	38479045
Hospital Revenue Code	301
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$124.00
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	$87.00
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	$52.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
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	$4.61

VANCOMYCIN, PEAK

Facility

$390.00

Service Code	HCPCS 80202
Hospital Charge Code	3008406
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VANCOMYCIN, PEAK

Facility

$390.00

Service Code	HCPCS 80202
Hospital Charge Code	3008406
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, TROUGH

Facility

$667.59

Service Code	HCPCS 80202
Hospital Charge Code	3008398
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

VANCOMYCIN, TROUGH

Facility

$667.59

Service Code	HCPCS 80202
Hospital Charge Code	3008398
Hospital Revenue Code	301
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$333.80
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	$333.80
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	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
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	$17.69

VANCOMYCIN,TROUGH

Facility

$174.00

Service Code	HCPCS 80202
Hospital Charge Code	38479047
Hospital Revenue Code	301
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$124.00
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	$87.00
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	$52.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
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	$4.61

VANCOMYCIN,TROUGH

Facility

$174.00

Service Code	HCPCS 80202
Hospital Charge Code	38479047
Hospital Revenue Code	301
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

VANCOMYCIN (VANCOCIN)

Facility

$174.00

Service Code	HCPCS 80202
Hospital Charge Code	38472702
Hospital Revenue Code	301
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

VANCOMYCIN (VANCOCIN)

Facility

$174.00

Service Code	HCPCS 80202
Hospital Charge Code	38472702
Hospital Revenue Code	301
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$124.00
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	$87.00
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	$52.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
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	$4.61

VANCOMYOCIN 2MG 100ML VPB

Facility

$225.12

Service Code	NDC 70594004402
Hospital Charge Code	60649032
Hospital Revenue Code	636
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$112.56
Rate for Payer: Aetna Commercial	$85.55
Rate for Payer: Aetna Medicare Advantage	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.41
Rate for Payer: Cigna Commercial	$112.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.48
Rate for Payer: Qualcare PPO/HMO/WC	$33.77
Rate for Payer: UnitedHealthcare Community & State	$5.43
Rate for Payer: Wellpoint Medicaid Managed Care	$5.97

VANCOMYOCIN 2MG 100ML VPB

Facility

$225.12

Service Code	NDC 70594004402
Hospital Charge Code	60649032
Hospital Revenue Code	636
Min. Negotiated Rate	$33.77
Max. Negotiated Rate	$54.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.48
Rate for Payer: Qualcare PPO/HMO/WC	$33.77

VANILLYLMANDELIC ACID (VMA)

Facility

$321.00

Service Code	HCPCS 84585
Hospital Charge Code	38472665
Hospital Revenue Code	301
Min. Negotiated Rate	$48.15
Max. Negotiated Rate	$48.15
Rate for Payer: Qualcare PPO/HMO/WC	$48.15

VANILLYLMANDELIC ACID (VMA)

Facility

$321.00

Service Code	HCPCS 84585
Hospital Charge Code	38472665
Hospital Revenue Code	301
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$160.50
Rate for Payer: Aetna Commercial	$42.16
Rate for Payer: Aetna Medicare Advantage	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.50
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	$55.95
Rate for Payer: Cigna Commercial	$160.50
Rate for Payer: Cigna Medicare Advantage	$15.50
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.50
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.50
Rate for Payer: Wellcare Medicare Advantage	$15.50
Rate for Payer: Wellpoint Medicaid Managed Care	$8.51

VANTIN 100MG/5ML SUSP100M

Facility

$170.00

Hospital Charge Code	60635222
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

VANTIN 100MG/5ML SUSP100M

Facility

$170.00

Hospital Charge Code	60635222
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.00
Rate for Payer: Oxford Commercial	$34.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$34.00
Rate for Payer: UnitedHealthcare Community & State	$4.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

VANTIN 100MG/5ML SUSP50ML

Facility

$74.00

Hospital Charge Code	60635220
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$28.12
Rate for Payer: Aetna Medicare Advantage	$22.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.87
Rate for Payer: Cigna Commercial	$37.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.20
Rate for Payer: Oxford Commercial	$14.80
Rate for Payer: Qualcare PPO/HMO/WC	$11.10
Rate for Payer: UnitedHealthcare Commercial	$14.80
Rate for Payer: UnitedHealthcare Community & State	$1.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.96

VANTIN 100MG/5ML SUSP50ML

Facility

$74.00

Hospital Charge Code	60635220
Hospital Revenue Code	250
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$11.10
Rate for Payer: Qualcare PPO/HMO/WC	$11.10

VANTIN 100MG/5ML SUSP75ML

Facility

$144.00

Hospital Charge Code	60635221
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

VANTIN 100MG/5ML SUSP75ML

Facility

$144.00

Hospital Charge Code	60635221
Hospital Revenue Code	250
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$28.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$28.80
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

VANTIN 100MGU/D TAB

Facility

$45.16

Service Code	NDC 781543820
Hospital Charge Code	60635215
Hospital Revenue Code	250
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$6.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.77

Know your out-of-pocket cost for care.

All Charges