Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FENTANYL 0.10 MG/2ML INJ

Facility

$12.86

Service Code	HCPCS J3010
Hospital Charge Code	60627708
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.43
Rate for Payer: Aetna Commercial	$4.89
Rate for Payer: Aetna Medicare Advantage	$3.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

FENTANYL 0.10 MG/2ML INJ

Facility

$12.86

Service Code	HCPCS J3010
Hospital Charge Code	60627708
Hospital Revenue Code	636
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$3.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

FENTANYL 100 MCG/HR TRANSDERM

Facility

$985.44

Service Code	NDC 50458010605
Hospital Charge Code	60627704
Hospital Revenue Code	250
Min. Negotiated Rate	$27.99
Max. Negotiated Rate	$492.72
Rate for Payer: Aetna Commercial	$374.47
Rate for Payer: Aetna Medicare Advantage	$295.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.29
Rate for Payer: Cigna Commercial	$492.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.21
Rate for Payer: Oxford Commercial	$197.09
Rate for Payer: Qualcare PPO/HMO/WC	$147.82
Rate for Payer: UnitedHealthcare Commercial	$197.09
Rate for Payer: UnitedHealthcare Community & State	$31.14
Rate for Payer: Wellpoint Medicaid Managed Care	$27.99

FENTANYL 100 MCG/HR TRANSDERM

Facility

$985.44

Service Code	NDC 50458010605
Hospital Charge Code	60627704
Hospital Revenue Code	250
Min. Negotiated Rate	$147.82
Max. Negotiated Rate	$147.82
Rate for Payer: Qualcare PPO/HMO/WC	$147.82

FENTANYL 2500MG/50ML VIAL

Facility

$4.00

Service Code	HCPCS J3010
Hospital Charge Code	60635772
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

FENTANYL 2500MG/50ML VIAL

Facility

$4.00

Service Code	HCPCS J3010
Hospital Charge Code	60635772
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

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 250 MCG/5 ML INJ

Facility

$19.30

Service Code	HCPCS J3010
Hospital Charge Code	60627709
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
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	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

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	$7.56
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	$69.23
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	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.56

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	$13.83
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	$126.57
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	$15.38
Rate for Payer: Wellpoint Medicaid Managed Care	$13.83

FENTANYL 50 MCG/ML 1ML VIAL

Facility

$8.24

Service Code	HCPCS J3010
Hospital Charge Code	606390304
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
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	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

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 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	$11.28
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	$103.30
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	$12.55
Rate for Payer: Wellpoint Medicaid Managed Care	$11.28

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	$2.40
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	$22.01
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	$2.67
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

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	$11.08
Max. Negotiated Rate	$225.41
Rate for Payer: Aetna Commercial	$169.02
Rate for Payer: Aetna Medicare Advantage	$201.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.41
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	$104.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.41
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$62.14
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: Longevity Health Plan of New Jersey Medicare Advantage	$62.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$49.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.14
Rate for Payer: Wellcare Medicare Advantage	$62.14
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

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	$3.29
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.05
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	$30.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.39
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

FENTAYL 12MCG/HR TDM

Facility

$136.01

Service Code	NDC 378911998
Hospital Charge Code	60630078
Hospital Revenue Code	250
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$51.68
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	$35.36
Rate for Payer: Oxford Commercial	$27.20
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Commercial	$27.20
Rate for Payer: UnitedHealthcare Community & State	$4.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

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

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

Know your out-of-pocket cost for care.

All Charges