Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VALVULOTOME EXPANDABLE LEMAITR

Facility

$1,231.00

Hospital Charge Code	270335315
Hospital Revenue Code	272
Min. Negotiated Rate	$34.96
Max. Negotiated Rate	$615.50
Rate for Payer: Aetna Commercial	$467.78
Rate for Payer: Aetna Medicare Advantage	$369.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$313.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$313.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$313.90
Rate for Payer: Cigna Commercial	$615.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.06
Rate for Payer: Oxford Commercial	$246.20
Rate for Payer: Qualcare PPO/HMO/WC	$184.65
Rate for Payer: UnitedHealthcare Commercial	$246.20
Rate for Payer: UnitedHealthcare Community & State	$38.90
Rate for Payer: Wellpoint Medicaid Managed Care	$34.96

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

VANCOCIN/500MG ADD

Facility

$51.00

Hospital Charge Code	60634816
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
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	$13.26
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	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

VANCOMYCIN

Facility

$40.20

Service Code	HCPCS J3373
Hospital Charge Code	60627331
Hospital Revenue Code	636
Min. Negotiated Rate	$1.14
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	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

VANCOMYCIN

Facility

$390.00

Service Code	HCPCS 80202
Hospital Charge Code	3008414
Hospital Revenue Code	301
Min. Negotiated Rate	$10.83
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	$49.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.12
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	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.12
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	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$11.08

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	$1.71
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	$15.70
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	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.71

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	$51.38
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	$57.16
Rate for Payer: Wellpoint Medicaid Managed Care	$51.38

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 125MG CAP

Facility

$209.78

Service Code	NDC 47781072902
Hospital Charge Code	606361048
Hospital Revenue Code	250
Min. Negotiated Rate	$5.96
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	$54.54
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	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

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	$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/300ML IVPB

Facility

$127.30

Service Code	HCPCS J3373
Hospital Charge Code	606390516
Hospital Revenue Code	636
Min. Negotiated Rate	$3.62
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	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$3.62

VANCOMYCIN 1.5GM VIAL

Facility

$193.90

Service Code	NDC 143915310
Hospital Charge Code	6063943394
Hospital Revenue Code	250
Min. Negotiated Rate	$5.51
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	$50.41
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	$6.13
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

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	$0.89
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	$8.11
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	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

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	$8.55
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	$78.29
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	$9.51
Rate for Payer: Wellpoint Medicaid Managed Care	$8.55

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 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	$10.98
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	$100.55
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	$12.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

VANCOMYCIN 2MG VIALS

Facility

$344.11

Service Code	NDC 72078006699
Hospital Charge Code	60649031
Hospital Revenue Code	636
Min. Negotiated Rate	$9.77
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	$10.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.77

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

Know your out-of-pocket cost for care.

All Charges