Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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 500MG/100ML IVPB

Facility

$72.03

Service Code	HCPCS J3373
Hospital Charge Code	606390500
Hospital Revenue Code	636
Min. Negotiated Rate	$2.05
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	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

VANCOMYCIN 500 MG (ORAL USE)

Facility

$64.66

Service Code	NDC 63323022110
Hospital Charge Code	60627329
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
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	$16.81
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	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.84

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	$0.74
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	$6.76
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	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

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	$32.88
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	$36.59
Rate for Payer: Wellpoint Medicaid Managed Care	$32.88

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 750MG VIAL (PER 500

Facility

$27.20

Hospital Charge Code	606351014
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
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	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

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 HCL 1.25GM/VIAL

Facility

$161.60

Service Code	HCPCS J3373
Hospital Charge Code	606390318
Hospital Revenue Code	636
Min. Negotiated Rate	$4.59
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	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$4.59

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

VANCOMYCIN IVPB 750MG/D5W 250M

Facility

$97.15

Service Code	NDC 409653101
Hospital Charge Code	60627333
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
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	$25.26
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	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

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	$4.94
Max. Negotiated Rate	$156.00
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	$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	$45.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
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	$4.94

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	$10.83
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, 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	$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	$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	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
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	$18.96

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

$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,TROUGH

Facility

$174.00

Service Code	HCPCS 80202
Hospital Charge Code	38479047
Hospital Revenue Code	301
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$156.00
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	$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	$45.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
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	$4.94

VANCOMYCIN (VANCOCIN)

Facility

$174.00

Service Code	HCPCS 80202
Hospital Charge Code	38472702
Hospital Revenue Code	301
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$156.00
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	$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	$45.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
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	$4.94

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

VANCOMYOCIN 2MG 100ML VPB

Facility

$225.12

Service Code	NDC 70594004402
Hospital Charge Code	60649032
Hospital Revenue Code	636
Min. Negotiated Rate	$6.39
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	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

Know your out-of-pocket cost for care.

All Charges