Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DILAUDID/4MG/TAB

Facility

$6.00

Hospital Charge Code	60632848
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DILAUDID/4MG/TAB

Facility

$6.00

Hospital Charge Code	60632848
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DILITERIA

Facility

$52.00

Hospital Charge Code	1810043
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

DILITERIA

Facility

$52.00

Hospital Charge Code	1810043
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

DILTIAZAM 25MG PER 5ML

Facility

$89.65

Hospital Charge Code	60628606
Hospital Revenue Code	250
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.45

DILTIAZAM 25MG PER 5ML

Facility

$89.65

Hospital Charge Code	60628606
Hospital Revenue Code	250
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.83
Rate for Payer: Aetna Commercial	$34.07
Rate for Payer: Aetna Medicare Advantage	$26.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.86
Rate for Payer: Cigna Commercial	$44.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.89
Rate for Payer: Oxford Commercial	$17.93
Rate for Payer: Qualcare PPO/HMO/WC	$13.45
Rate for Payer: UnitedHealthcare Commercial	$17.93
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

DILTIAZEM 100 MG INJ (ADD-VAN)

Facility

$166.43

Service Code	NDC 409435003
Hospital Charge Code	60630102
Hospital Revenue Code	250
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$83.22
Rate for Payer: Aetna Commercial	$63.24
Rate for Payer: Aetna Medicare Advantage	$49.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.44
Rate for Payer: Cigna Commercial	$83.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.93
Rate for Payer: Oxford Commercial	$33.29
Rate for Payer: Qualcare PPO/HMO/WC	$24.96
Rate for Payer: UnitedHealthcare Commercial	$33.29
Rate for Payer: UnitedHealthcare Community & State	$4.01
Rate for Payer: Wellpoint Medicaid Managed Care	$4.41

DILTIAZEM 100 MG INJ (ADD-VAN)

Facility

$166.43

Service Code	NDC 409435003
Hospital Charge Code	60630102
Hospital Revenue Code	250
Min. Negotiated Rate	$24.96
Max. Negotiated Rate	$24.96
Rate for Payer: Qualcare PPO/HMO/WC	$24.96

DILTIAZEM 120 MG SR CAP

Facility

$13.65

Hospital Charge Code	60627557
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

DILTIAZEM 120 MG SR CAP

Facility

$13.65

Hospital Charge Code	60627557
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

DILTIAZEM 1.25MG/25ML

Facility

$154.00

Hospital Charge Code	60635499
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$77.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Oxford Commercial	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$30.80
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

DILTIAZEM 1.25MG/25ML

Facility

$154.00

Hospital Charge Code	60635499
Hospital Revenue Code	250
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

DILTIAZEM 125 MG/25ML INJ

Facility

$72.36

Service Code	NDC 55390056530
Hospital Charge Code	60629215
Hospital Revenue Code	250
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.18
Rate for Payer: Aetna Commercial	$27.50
Rate for Payer: Aetna Medicare Advantage	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.45
Rate for Payer: Cigna Commercial	$36.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.71
Rate for Payer: Oxford Commercial	$14.47
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Commercial	$14.47
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

DILTIAZEM 125 MG/25ML INJ

Facility

$72.36

Service Code	NDC 55390056530
Hospital Charge Code	60629215
Hospital Revenue Code	250
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$10.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

DILTIAZEM 25 MG/5ML INJ

Facility

$17.69

Service Code	NDC 55390056505
Hospital Charge Code	60627553
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.65

DILTIAZEM 25 MG/5ML INJ

Facility

$17.69

Service Code	NDC 55390056505
Hospital Charge Code	60627553
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$6.72
Rate for Payer: Aetna Medicare Advantage	$5.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.51
Rate for Payer: Cigna Commercial	$8.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.31
Rate for Payer: Oxford Commercial	$3.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Commercial	$3.54
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

DILTIAZEM 30 MG TAB

Facility

$4.00

Service Code	NDC 51079074520
Hospital Charge Code	60627554
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DILTIAZEM 30 MG TAB

Facility

$4.00

Service Code	NDC 51079074520
Hospital Charge Code	60627554
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DILTIAZEM 50 MG/10ML INJ

Facility

$35.44

Service Code	NDC 55390056510
Hospital Charge Code	6016414
Hospital Revenue Code	250
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.32

DILTIAZEM 50 MG/10ML INJ

Facility

$35.44

Service Code	NDC 55390056510
Hospital Charge Code	6016414
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$17.72
Rate for Payer: Aetna Commercial	$13.47
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.04
Rate for Payer: Cigna Commercial	$17.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.63
Rate for Payer: Oxford Commercial	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.32
Rate for Payer: UnitedHealthcare Commercial	$7.09
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

DILTIAZEM 60 MG SR CAP

Facility

$7.25

Hospital Charge Code	6022420
Hospital Revenue Code	251
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

DILTIAZEM 60 MG SR CAP

Facility

$7.25

Hospital Charge Code	6022420
Hospital Revenue Code	251
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

DILTIAZEM 60 MG TAB

Facility

$4.69

Service Code	NDC 51079074620
Hospital Charge Code	60627555
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

DILTIAZEM 60 MG TAB

Facility

$4.69

Service Code	NDC 51079074620
Hospital Charge Code	60627555
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare Advantage	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.41
Rate for Payer: Oxford Commercial	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$0.94
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

DILTIAZEM 90 MG SR CAP

Facility

$11.25

Hospital Charge Code	60627558
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

Know your out-of-pocket cost for care.

All Charges