Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FENTANYL 250MCG/5ML****

Facility

$18.00

Service Code	HCPCS J3010
Hospital Charge Code	6017040
Hospital Revenue Code	259
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

FENTANYL 250MCG/5ML****

Facility

$18.00

Service Code	HCPCS J3010
Hospital Charge Code	6017040
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

FENTANYL 250 MCG/5 ML INJ

Facility

$19.30

Service Code	HCPCS J3010
Hospital Charge Code	60627709
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

FENTANYL 250 MCG/5 ML INJ

Facility

$19.30

Service Code	HCPCS J3010
Hospital Charge Code	60627709
Hospital Revenue Code	636
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

FENTANYL 25MCG/HR DURAGESIC

Facility

$63.00

Hospital Charge Code	6016166
Hospital Revenue Code	252
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

FENTANYL 25MCG/HR DURAGESIC

Facility

$63.00

Hospital Charge Code	6016166
Hospital Revenue Code	252
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.90
Rate for Payer: Oxford Commercial	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$12.60
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

FENTANYL 25 MCG/HR TRANSDERM

Facility

$266.26

Service Code	NDC 50458010205
Hospital Charge Code	60627705
Hospital Revenue Code	250
Min. Negotiated Rate	$39.94
Max. Negotiated Rate	$39.94
Rate for Payer: Qualcare PPO/HMO/WC	$39.94

FENTANYL 25 MCG/HR TRANSDERM

Facility

$266.26

Service Code	NDC 50458010205
Hospital Charge Code	60627705
Hospital Revenue Code	250
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$133.13
Rate for Payer: Aetna Commercial	$101.18
Rate for Payer: Aetna Medicare Advantage	$79.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.90
Rate for Payer: Cigna Commercial	$133.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.88
Rate for Payer: Oxford Commercial	$53.25
Rate for Payer: Qualcare PPO/HMO/WC	$39.94
Rate for Payer: UnitedHealthcare Commercial	$53.25
Rate for Payer: UnitedHealthcare Community & State	$6.42
Rate for Payer: Wellpoint Medicaid Managed Care	$7.06

FENTANYL 50MCG/HR DURAGESIC

Facility

$94.00

Hospital Charge Code	6016174
Hospital Revenue Code	252
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$47.00
Rate for Payer: Aetna Commercial	$35.72
Rate for Payer: Aetna Medicare Advantage	$28.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.97
Rate for Payer: Cigna Commercial	$47.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.20
Rate for Payer: Oxford Commercial	$18.80
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$18.80
Rate for Payer: UnitedHealthcare Community & State	$2.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.49

FENTANYL 50MCG/HR DURAGESIC

Facility

$94.00

Hospital Charge Code	6016174
Hospital Revenue Code	252
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.10

FENTANYL 50 MCG/HR TRANSDERM

Facility

$486.82

Service Code	NDC 50458010405
Hospital Charge Code	60627706
Hospital Revenue Code	250
Min. Negotiated Rate	$73.02
Max. Negotiated Rate	$73.02
Rate for Payer: Qualcare PPO/HMO/WC	$73.02

FENTANYL 50 MCG/HR TRANSDERM

Facility

$486.82

Service Code	NDC 50458010405
Hospital Charge Code	60627706
Hospital Revenue Code	250
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$243.41
Rate for Payer: Aetna Commercial	$184.99
Rate for Payer: Aetna Medicare Advantage	$146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.14
Rate for Payer: Cigna Commercial	$243.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.05
Rate for Payer: Oxford Commercial	$97.36
Rate for Payer: Qualcare PPO/HMO/WC	$73.02
Rate for Payer: UnitedHealthcare Commercial	$97.36
Rate for Payer: UnitedHealthcare Community & State	$11.73
Rate for Payer: Wellpoint Medicaid Managed Care	$12.90

FENTANYL 50 MCG/ML 1ML VIAL

Facility

$8.24

Service Code	HCPCS J3010
Hospital Charge Code	606390304
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.99
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

FENTANYL 50 MCG/ML 1ML VIAL

Facility

$8.24

Service Code	HCPCS J3010
Hospital Charge Code	606390304
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.99
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

FENTANYL 75MCG/HR DURAGESIC

Facility

$141.00

Hospital Charge Code	6016182
Hospital Revenue Code	252
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

FENTANYL 75MCG/HR DURAGESIC

Facility

$141.00

Hospital Charge Code	6016182
Hospital Revenue Code	252
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna Commercial	$53.58
Rate for Payer: Aetna Medicare Advantage	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.95
Rate for Payer: Cigna Commercial	$70.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.30
Rate for Payer: Oxford Commercial	$28.20
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$28.20
Rate for Payer: UnitedHealthcare Community & State	$3.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.74

FENTANYL 75 MCG/HR TRANSDERM

Facility

$397.31

Service Code	NDC 50458010505
Hospital Charge Code	60627707
Hospital Revenue Code	250
Min. Negotiated Rate	$59.60
Max. Negotiated Rate	$59.60
Rate for Payer: Qualcare PPO/HMO/WC	$59.60

FENTANYL 75 MCG/HR TRANSDERM

Facility

$397.31

Service Code	NDC 50458010505
Hospital Charge Code	60627707
Hospital Revenue Code	250
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$198.66
Rate for Payer: Aetna Commercial	$150.98
Rate for Payer: Aetna Medicare Advantage	$119.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.31
Rate for Payer: Cigna Commercial	$198.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.19
Rate for Payer: Oxford Commercial	$79.46
Rate for Payer: Qualcare PPO/HMO/WC	$59.60
Rate for Payer: UnitedHealthcare Commercial	$79.46
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.53

FENTANYL AMP 100MCG/2ML****

Facility

$8.00

Service Code	HCPCS J3010
Hospital Charge Code	6017057
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

FENTANYL AMP 100MCG/2ML****

Facility

$8.00

Service Code	HCPCS J3010
Hospital Charge Code	6017057
Hospital Revenue Code	259
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

FENTANYL & BUPIVICAINE 200 ML

Facility

$84.65

Hospital Charge Code	606361038
Hospital Revenue Code	250
Min. Negotiated Rate	$12.70
Max. Negotiated Rate	$12.70
Rate for Payer: Qualcare PPO/HMO/WC	$12.70

FENTANYL & BUPIVICAINE 200 ML

Facility

$84.65

Hospital Charge Code	606361038
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$42.33
Rate for Payer: Aetna Commercial	$32.17
Rate for Payer: Aetna Medicare Advantage	$25.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.59
Rate for Payer: Cigna Commercial	$42.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.39
Rate for Payer: Oxford Commercial	$16.93
Rate for Payer: Qualcare PPO/HMO/WC	$12.70
Rate for Payer: UnitedHealthcare Commercial	$16.93
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

FENTANYL CITRATE/0.05MG/1

Facility

$15.00

Hospital Charge Code	60632972
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

FENTANYL CITRATE/0.05MG/1

Facility

$15.00

Hospital Charge Code	60632972
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

FENTANYL CITRATE/0.05MG/1

Facility

$24.00

Hospital Charge Code	60632973
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

Know your out-of-pocket cost for care.

All Charges