Heights University Hospital

All Charges

Charge

Type

Setting

Price

FENTANYL 250 MCG/5 ML INJ

Facility

$19.30

Service Code	HCPCS J3010
Hospital Charge Code	60627709
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$5.79
Rate for Payer: Aetna Commercial	$5.79
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	$1.16
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	$8.19
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$18.90
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	$8.19
Rate for Payer: Oxford Commercial	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$31.50

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 25 MCG/HR TRANSDERM

Facility

$266.26

Service Code	NDC 50458010205
Hospital Charge Code	60627705
Hospital Revenue Code	250
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$133.13
Rate for Payer: Aetna Commercial	$79.88
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	$34.61
Rate for Payer: Oxford Commercial	$133.13
Rate for Payer: Qualcare PPO/HMO/WC	$39.94
Rate for Payer: UnitedHealthcare Commercial	$133.13

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 50MCG/HR DURAGESIC

Facility

$94.00

Hospital Charge Code	6016174
Hospital Revenue Code	252
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$47.00
Rate for Payer: Aetna Commercial	$28.20
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	$12.22
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$47.00

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	$63.29
Max. Negotiated Rate	$243.41
Rate for Payer: Aetna Commercial	$146.05
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	$63.29
Rate for Payer: Oxford Commercial	$243.41
Rate for Payer: Qualcare PPO/HMO/WC	$73.02
Rate for Payer: UnitedHealthcare Commercial	$243.41

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/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 50 MCG/ML 1ML VIAL

Facility

$8.24

Service Code	HCPCS J3010
Hospital Charge Code	606390304
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.47
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	$1.16
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	$18.33
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna Commercial	$42.30
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	$18.33
Rate for Payer: Oxford Commercial	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$70.50

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 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	$51.65
Max. Negotiated Rate	$198.66
Rate for Payer: Aetna Commercial	$119.19
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	$51.65
Rate for Payer: Oxford Commercial	$198.66
Rate for Payer: Qualcare PPO/HMO/WC	$59.60
Rate for Payer: UnitedHealthcare Commercial	$198.66

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 AMP 100MCG/2ML****

Facility

$8.00

Service Code	HCPCS J3010
Hospital Charge Code	6017057
Hospital Revenue Code	259
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
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	$1.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

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	$11.00
Max. Negotiated Rate	$42.33
Rate for Payer: Aetna Commercial	$25.39
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	$11.00
Rate for Payer: Oxford Commercial	$42.33
Rate for Payer: Qualcare PPO/HMO/WC	$12.70
Rate for Payer: UnitedHealthcare Commercial	$42.33

FENTANYL CITRATE/0.05MG/1

Facility

$15.00

Hospital Charge Code	60632972
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
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	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

FENTANYL CITRATE/0.05MG/1

Facility

$24.00

Hospital Charge Code	60632973
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

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

$24.00

Hospital Charge Code	60632973
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$7.20
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	$3.12
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$12.00

FENTANYL CITRATE/0.1MG/2M

Facility

$15.00

Hospital Charge Code	60632974
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/0.1MG/2M

Facility

$15.00

Hospital Charge Code	60632974
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
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	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

Know your out-of-pocket cost for care.

All Charges