Heights University Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN 1.25GM/250ML

Facility

$1,809.00

Service Code	HCPCS J3373
Hospital Charge Code	606390398
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$542.70
Rate for Payer: Aetna Commercial	$542.70
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	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.78
Rate for Payer: Qualcare PPO/HMO/WC	$271.35

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	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
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	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

VANCOMYCIN 125MG CAP

Facility

$209.78

Service Code	NDC 47781072902
Hospital Charge Code	606361048
Hospital Revenue Code	250
Min. Negotiated Rate	$27.27
Max. Negotiated Rate	$104.89
Rate for Payer: Aetna Commercial	$62.93
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	$27.27
Rate for Payer: Oxford Commercial	$104.89
Rate for Payer: Qualcare PPO/HMO/WC	$31.47
Rate for Payer: UnitedHealthcare Commercial	$104.89

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 1.5GM/300ML IVPB

Facility

$127.30

Service Code	HCPCS J3373
Hospital Charge Code	606390516
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$38.19
Rate for Payer: Aetna Commercial	$38.19
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	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.81
Rate for Payer: Qualcare PPO/HMO/WC	$19.09

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	$25.21
Max. Negotiated Rate	$96.95
Rate for Payer: Aetna Commercial	$58.17
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	$25.21
Rate for Payer: Oxford Commercial	$96.95
Rate for Payer: Qualcare PPO/HMO/WC	$29.09
Rate for Payer: UnitedHealthcare Commercial	$96.95

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	$4.68
Max. Negotiated Rate	$4.68
Rate for Payer: Qualcare PPO/HMO/WC	$4.68

VANCOMYCIN 1.75MG/350ML

Facility

$31.20

Service Code	HCPCS J3373
Hospital Charge Code	60639604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$15.60
Rate for Payer: Aetna Commercial	$9.36
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	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.06
Rate for Payer: Oxford Commercial	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.68
Rate for Payer: UnitedHealthcare Commercial	$15.60

VANCOMYCIN 1.75MG VIALS

Facility

$301.10

Service Code	NDC 72078006599
Hospital Charge Code	606494030
Hospital Revenue Code	250
Min. Negotiated Rate	$39.14
Max. Negotiated Rate	$150.55
Rate for Payer: Aetna Commercial	$90.33
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	$39.14
Rate for Payer: Oxford Commercial	$150.55
Rate for Payer: Qualcare PPO/HMO/WC	$45.16
Rate for Payer: UnitedHealthcare Commercial	$150.55

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	$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	$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	$29.51
Max. Negotiated Rate	$113.50
Rate for Payer: Aetna Commercial	$68.10
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	$29.51
Rate for Payer: Oxford Commercial	$113.50
Rate for Payer: Qualcare PPO/HMO/WC	$34.05
Rate for Payer: UnitedHealthcare Commercial	$113.50

VANCOMYCIN/1GM

Facility

$258.00

Hospital Charge Code	60634124
Hospital Revenue Code	250
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$77.40
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	$33.54
Rate for Payer: Oxford Commercial	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$129.00

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

Facility

$21.00

Hospital Charge Code	60635463
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
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	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

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	$50.27
Max. Negotiated Rate	$193.36
Rate for Payer: Aetna Commercial	$116.02
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	$50.27
Rate for Payer: Oxford Commercial	$193.36
Rate for Payer: Qualcare PPO/HMO/WC	$58.01
Rate for Payer: UnitedHealthcare Commercial	$193.36

VANCOMYCIN 2 GM/400ML BAG

Facility

$33.00

Service Code	HCPCS J3373
Hospital Charge Code	606390600
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna Commercial	$9.90
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	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

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	$51.62
Max. Negotiated Rate	$172.06
Rate for Payer: Aetna Commercial	$103.23
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

Know your out-of-pocket cost for care.

All Charges