Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DILTIAZEM 90 MG SR CAP

Facility

$11.25

Hospital Charge Code	60627558
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DILTIAZEM CAP CD 180MG

Facility

$12.13

Service Code	NDC 63739028410
Hospital Charge Code	6009591
Hospital Revenue Code	251
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$1.82
Rate for Payer: Qualcare PPO/HMO/WC	$1.82

DILTIAZEM CAP CD 180MG

Facility

$12.13

Service Code	NDC 63739028410
Hospital Charge Code	6009591
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.07
Rate for Payer: Aetna Commercial	$4.61
Rate for Payer: Aetna Medicare Advantage	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.09
Rate for Payer: Cigna Commercial	$6.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.82
Rate for Payer: UnitedHealthcare Commercial	$2.43
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DILTIAZEM CAP CD 240MG

Facility

$5.36

Service Code	NDC 68084005401
Hospital Charge Code	6009492
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

DILTIAZEM CAP CD 240MG

Facility

$5.36

Service Code	NDC 68084005401
Hospital Charge Code	6009492
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

DILTIAZEM CAP CD 300MG

Facility

$17.82

Service Code	NDC 62037060090
Hospital Charge Code	60627556
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.67

DILTIAZEM CAP CD 300MG

Facility

$19.85

Hospital Charge Code	6009484
Hospital Revenue Code	251
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

DILTIAZEM CAP CD 300MG

Facility

$19.85

Hospital Charge Code	6009484
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

DILTIAZEM CAP CD 300MG

Facility

$17.82

Service Code	NDC 62037060090
Hospital Charge Code	60627556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.91
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Aetna Medicare Advantage	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.54
Rate for Payer: Cigna Commercial	$8.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.35
Rate for Payer: Oxford Commercial	$3.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.67
Rate for Payer: UnitedHealthcare Commercial	$3.56
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

DILTIAZEM CAP CR 120MG

Facility

$9.65

Hospital Charge Code	60628860
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

DILTIAZEM CAP CR 120MG

Facility

$9.65

Hospital Charge Code	60628860
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

DILTIAZEM CAP CR 240MG

Facility

$11.25

Hospital Charge Code	60629043
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

DILTIAZEM CAP CR 240MG

Facility

$11.25

Hospital Charge Code	60629043
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DILTIAZEM CAP SR 120MG

Facility

$4.00

Service Code	NDC 68084005201
Hospital Charge Code	6009575
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DILTIAZEM CAP SR 120MG

Facility

$4.00

Service Code	NDC 68084005201
Hospital Charge Code	6009575
Hospital Revenue Code	251
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 HCL 125 MG/25 ML VIA

Facility

$117.85

Hospital Charge Code	60629314
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$58.92
Rate for Payer: Aetna Commercial	$44.78
Rate for Payer: Aetna Medicare Advantage	$35.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.05
Rate for Payer: Cigna Commercial	$58.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.35
Rate for Payer: Oxford Commercial	$23.57
Rate for Payer: Qualcare PPO/HMO/WC	$17.68
Rate for Payer: UnitedHealthcare Commercial	$23.57
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

DILTIAZEM HCL 125 MG/25 ML VIA

Facility

$117.85

Hospital Charge Code	60629314
Hospital Revenue Code	250
Min. Negotiated Rate	$17.68
Max. Negotiated Rate	$17.68
Rate for Payer: Qualcare PPO/HMO/WC	$17.68

DILTIAZEM HCL INJ 25MG/5ML

Facility

$73.00

Hospital Charge Code	6016422
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

DILTIAZEM HCL INJ 25MG/5ML

Facility

$73.00

Hospital Charge Code	6016422
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

DILTIAZEM TAB 30MG

Facility

$1.95

Hospital Charge Code	6022412
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

DILTIAZEM TAB 30MG

Facility

$1.95

Hospital Charge Code	6022412
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

DIL URETH STRICT SND,MALE INIT

Facility

$1,368.65

Service Code	HCPCS 53600
Hospital Charge Code	1600000664
Hospital Revenue Code	360
Min. Negotiated Rate	$205.30
Max. Negotiated Rate	$205.30
Rate for Payer: Qualcare PPO/HMO/WC	$205.30

DIL URETH STRICT SND,MALE INIT

Facility

$1,368.65

Service Code	HCPCS 53600
Hospital Charge Code	1600000664
Hospital Revenue Code	360
Min. Negotiated Rate	$32.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.47
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.60
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$205.30
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$32.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$36.27

DILUTION OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86976
Hospital Charge Code	3100185
Hospital Revenue Code	300
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$124.03
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
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	$25.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DILUTION OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86976
Hospital Charge Code	3100185
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges