Heights 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	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DILAUDID/4MG/TAB

Facility

$6.00

Hospital Charge Code	60632848
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
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	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

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

DILITERIA

Facility

$52.00

Hospital Charge Code	1810043
Hospital Revenue Code	272
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$15.60
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	$6.76
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$26.00

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	$11.65
Max. Negotiated Rate	$44.83
Rate for Payer: Aetna Commercial	$26.89
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	$11.65
Rate for Payer: Oxford Commercial	$44.83
Rate for Payer: Qualcare PPO/HMO/WC	$13.45
Rate for Payer: UnitedHealthcare Commercial	$44.83

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 100 MG INJ (ADD-VAN)

Facility

$166.43

Service Code	NDC 409435003
Hospital Charge Code	60630102
Hospital Revenue Code	250
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$83.22
Rate for Payer: Aetna Commercial	$49.93
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	$21.64
Rate for Payer: Oxford Commercial	$83.22
Rate for Payer: Qualcare PPO/HMO/WC	$24.96
Rate for Payer: UnitedHealthcare Commercial	$83.22

DILTIAZEM 120 MG SR CAP

Facility

$13.65

Hospital Charge Code	60627557
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
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	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

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	$20.02
Max. Negotiated Rate	$77.00
Rate for Payer: Aetna Commercial	$46.20
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	$20.02
Rate for Payer: Oxford Commercial	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$77.00

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	$10.85
Max. Negotiated Rate	$10.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

DILTIAZEM 125 MG/25ML INJ

Facility

$72.36

Service Code	NDC 55390056530
Hospital Charge Code	60629215
Hospital Revenue Code	250
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$36.18
Rate for Payer: Aetna Commercial	$21.71
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	$9.41
Rate for Payer: Oxford Commercial	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Commercial	$36.18

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	$2.30
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$5.31
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	$2.30
Rate for Payer: Oxford Commercial	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Commercial	$8.85

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	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

DILTIAZEM 50 MG/10ML INJ

Facility

$35.44

Service Code	NDC 55390056510
Hospital Charge Code	6016414
Hospital Revenue Code	250
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$17.72
Rate for Payer: Aetna Commercial	$10.63
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	$4.61
Rate for Payer: Oxford Commercial	$17.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.32
Rate for Payer: UnitedHealthcare Commercial	$17.72

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 60 MG SR CAP

Facility

$7.25

Hospital Charge Code	6022420
Hospital Revenue Code	251
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
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	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

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 TAB

Facility

$4.69

Service Code	NDC 51079074620
Hospital Charge Code	60627555
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.41
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	$0.61
Rate for Payer: Oxford Commercial	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$2.35

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 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

Know your out-of-pocket cost for care.

All Charges