Heights 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	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
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	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

DILTIAZEM CAP CD 180MG

Facility

$12.13

Service Code	NDC 63739028410
Hospital Charge Code	6009591
Hospital Revenue Code	251
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$6.07
Rate for Payer: Aetna Commercial	$3.64
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	$1.58
Rate for Payer: Oxford Commercial	$6.07
Rate for Payer: Qualcare PPO/HMO/WC	$1.82
Rate for Payer: UnitedHealthcare Commercial	$6.07

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 240MG

Facility

$5.36

Service Code	NDC 68084005401
Hospital Charge Code	6009492
Hospital Revenue Code	251
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$1.61
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	$0.70
Rate for Payer: Oxford Commercial	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$2.68

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 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

$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	$2.58
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$5.96
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	$2.58
Rate for Payer: Oxford Commercial	$9.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$9.93

DILTIAZEM CAP CD 300MG

Facility

$17.82

Service Code	NDC 62037060090
Hospital Charge Code	60627556
Hospital Revenue Code	250
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$8.91
Rate for Payer: Aetna Commercial	$5.35
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	$2.32
Rate for Payer: Oxford Commercial	$8.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.67
Rate for Payer: UnitedHealthcare Commercial	$8.91

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	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
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	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

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 CR 240MG

Facility

$11.25

Hospital Charge Code	60629043
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
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	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

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	$0.52
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 HCL 125 MG/25 ML VIA

Facility

$117.85

Hospital Charge Code	60629314
Hospital Revenue Code	250
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$58.92
Rate for Payer: Aetna Commercial	$35.35
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	$15.32
Rate for Payer: Oxford Commercial	$58.92
Rate for Payer: Qualcare PPO/HMO/WC	$17.68
Rate for Payer: UnitedHealthcare Commercial	$58.92

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	$9.49
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$21.90
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	$9.49
Rate for Payer: Oxford Commercial	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$36.50

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	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
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	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

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	$177.92
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$410.60
Rate for Payer: Aetna Medicare Advantage	$410.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.01
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$205.30
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DILUTION OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86976
Hospital Charge Code	3100185
Hospital Revenue Code	300
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

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

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