Heights University Hospital

All Charges

Charge

Type

Setting

Price

FENTANYL CITRATE/0.25MG/5

Facility

$27.00

Hospital Charge Code	60632975
Hospital Revenue Code	636
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

FENTANYL CITRATE/0.25MG/5

Facility

$27.00

Hospital Charge Code	60632975
Hospital Revenue Code	636
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

FENTANYL II QUAL URINE

Facility

$390.00

Service Code	HCPCS 80307
Hospital Charge Code	4010803072
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FENTANYL II QUAL URINE

Facility

$390.00

Service Code	HCPCS 80307
Hospital Charge Code	4010803072
Hospital Revenue Code	301
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$227.68
Rate for Payer: Aetna Commercial	$201.33
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.68
Rate for Payer: Cigna Commercial	$62.14
Rate for Payer: Cigna Medicare Advantage	$31.07
Rate for Payer: Clover Medicare Advantage	$59.03
Rate for Payer: EmblemHealth Commercial	$186.42
Rate for Payer: Humana Medicare Advantage	$64.00
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
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$65.87
Rate for Payer: Wellcare Medicare Advantage	$62.14

FENTANYL LEVEL QUANTITATIVE

Facility

$115.91

Service Code	HCPCS 80354
Hospital Charge Code	401180354
Hospital Revenue Code	301
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$17.39
Rate for Payer: Qualcare PPO/HMO/WC	$17.39

FENTANYL LEVEL QUANTITATIVE

Facility

$115.91

Service Code	HCPCS 80354
Hospital Charge Code	401180354
Hospital Revenue Code	301
Min. Negotiated Rate	$15.07
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.77
Rate for Payer: Aetna Medicare Advantage	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.56
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.39
Rate for Payer: UnitedHealthcare Commercial	$114.00

FENTAYL 12MCG/HR TDM

Facility

$136.01

Service Code	NDC 378911998
Hospital Charge Code	60630078
Hospital Revenue Code	250
Min. Negotiated Rate	$17.68
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna Medicare Advantage	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.68
Rate for Payer: Cigna Commercial	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.68
Rate for Payer: Oxford Commercial	$68.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Commercial	$68.00

FENTAYL 12MCG/HR TDM

Facility

$136.01

Service Code	NDC 378911998
Hospital Charge Code	60630078
Hospital Revenue Code	250
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

FEOSOL/159MG/CAP

Facility

$1.00

Hospital Charge Code	60632977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

FEOSOL/159MG/CAP

Facility

$1.00

Hospital Charge Code	60632976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

FEOSOL/159MG/CAP

Facility

$1.00

Hospital Charge Code	60632977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

FEOSOL/159MG/CAP

Facility

$1.00

Hospital Charge Code	60632976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

FERANCEE-HP/TAB

Facility

$3.00

Hospital Charge Code	60632979
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FERANCEE-HP/TAB

Facility

$3.00

Hospital Charge Code	60632979
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

FERATAB/300MG/TAB

Facility

$3.00

Hospital Charge Code	60632980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FERATAB/300MG/TAB

Facility

$3.00

Hospital Charge Code	60632980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

FERMOAL COMP POST STB SZ 3.5 L

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685336
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

FERMOAL COMP POST STB SZ 3.5 L

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685336
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

FERMOAL COMP POST STB SZ 3 LEF

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270684770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

FERMOAL COMP POST STB SZ 3 LEF

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270684770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

FERMORAL HEAD 12/14 TAPER 7MM

Facility

$2,000.00

Hospital Charge Code	270675289
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FERMORAL HEAD 12/14 TAPER 7MM

Facility

$2,000.00

Hospital Charge Code	270675289
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FERMORAL HEAD CEREMIC BIOLOX D

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688631
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

FERMORAL HEAD CEREMIC BIOLOX D

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688631
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

FERMORAL HEAD COCR -3.5x36MM

Facility

$3,311.05

Hospital Charge Code	270675769
Hospital Revenue Code	278
Min. Negotiated Rate	$496.66
Max. Negotiated Rate	$801.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$662.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$801.27
Rate for Payer: Qualcare PPO/HMO/WC	$496.66

Know your out-of-pocket cost for care.

All Charges