Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OCTREOSCAN UD

Facility

$7,577.65

Hospital Charge Code	270626959
Hospital Revenue Code	272
Min. Negotiated Rate	$182.62
Max. Negotiated Rate	$3,788.82
Rate for Payer: Aetna Commercial	$2,879.51
Rate for Payer: Aetna Medicare Advantage	$2,273.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,932.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,932.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,932.30
Rate for Payer: Cigna Commercial	$3,788.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,273.30
Rate for Payer: Oxford Commercial	$1,515.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.65
Rate for Payer: UnitedHealthcare Commercial	$1,515.53
Rate for Payer: UnitedHealthcare Community & State	$182.62
Rate for Payer: Wellpoint Medicaid Managed Care	$200.81

OCTREOSCAN UD

Facility

$7,577.65

Hospital Charge Code	270626959
Hospital Revenue Code	272
Min. Negotiated Rate	$1,136.65
Max. Negotiated Rate	$1,136.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.65

OCTREOTIDE 100MCG/ML

Facility

$106.00

Hospital Charge Code	60635669
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Oxford Commercial	$21.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$21.20
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

OCTREOTIDE 100MCG/ML

Facility

$106.00

Hospital Charge Code	60635669
Hospital Revenue Code	250
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

OCTREOTIDE 100 MCG/ML INJ

Facility

$205.56

Service Code	HCPCS J2354
Hospital Charge Code	60628540
Hospital Revenue Code	636
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$102.78
Rate for Payer: Aetna Commercial	$78.11
Rate for Payer: Aetna Medicare Advantage	$61.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.42
Rate for Payer: Cigna Commercial	$102.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.75
Rate for Payer: Qualcare PPO/HMO/WC	$30.83
Rate for Payer: UnitedHealthcare Community & State	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

OCTREOTIDE 100 MCG/ML INJ

Facility

$205.56

Service Code	HCPCS J2354
Hospital Charge Code	60628540
Hospital Revenue Code	636
Min. Negotiated Rate	$30.83
Max. Negotiated Rate	$49.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.75
Rate for Payer: Qualcare PPO/HMO/WC	$30.83

OCTREOTIDE 1/MG INJ

Facility

$27.00

Hospital Charge Code	60634868
Hospital Revenue Code	636
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
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
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

OCTREOTIDE 1/MG INJ

Facility

$27.00

Hospital Charge Code	60634868
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

OCTREOTIDE 20MG/5ML LAR INJ

Facility

$10,849.00

Service Code	HCPCS J2352
Hospital Charge Code	60629155
Hospital Revenue Code	636
Min. Negotiated Rate	$1,627.35
Max. Negotiated Rate	$2,625.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.35

OCTREOTIDE 20MG/5ML LAR INJ

Facility

$10,849.00

Service Code	HCPCS J2352
Hospital Charge Code	60629155
Hospital Revenue Code	636
Min. Negotiated Rate	$261.46
Max. Negotiated Rate	$5,424.50
Rate for Payer: Aetna Commercial	$4,122.62
Rate for Payer: Aetna Medicare Advantage	$3,254.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,766.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,766.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,766.49
Rate for Payer: Cigna Commercial	$5,424.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.35
Rate for Payer: UnitedHealthcare Community & State	$261.46
Rate for Payer: Wellpoint Medicaid Managed Care	$287.50

OCTREOTIDE 20 MG LAR INJ

Facility

$10,428.75

Hospital Charge Code	60629302
Hospital Revenue Code	636
Min. Negotiated Rate	$251.33
Max. Negotiated Rate	$5,214.38
Rate for Payer: Aetna Commercial	$3,962.93
Rate for Payer: Aetna Medicare Advantage	$3,128.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,659.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,659.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,659.33
Rate for Payer: Cigna Commercial	$5,214.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,523.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,564.31
Rate for Payer: UnitedHealthcare Community & State	$251.33
Rate for Payer: Wellpoint Medicaid Managed Care	$276.36

OCTREOTIDE 20 MG LAR INJ

Facility

$10,428.75

Hospital Charge Code	60629302
Hospital Revenue Code	636
Min. Negotiated Rate	$1,564.31
Max. Negotiated Rate	$2,523.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,523.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,564.31

OCTREOTIDE 30 MG LAR INJ

Facility

$36,803.90

Service Code	HCPCS J2353
Hospital Charge Code	60629867
Hospital Revenue Code	636
Min. Negotiated Rate	$5,520.59
Max. Negotiated Rate	$8,906.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,906.54
Rate for Payer: Qualcare PPO/HMO/WC	$5,520.59

OCTREOTIDE 30 MG LAR INJ

Facility

$36,803.90

Service Code	HCPCS J2353
Hospital Charge Code	60629867
Hospital Revenue Code	636
Min. Negotiated Rate	$178.93
Max. Negotiated Rate	$8,906.54
Rate for Payer: Aetna Commercial	$512.31
Rate for Payer: Aetna Medicare Advantage	$610.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$679.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$679.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$188.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$679.89
Rate for Payer: Cigna Medicare Advantage	$188.35
Rate for Payer: Clover Medicare Advantage	$178.93
Rate for Payer: EmblemHealth Commercial	$565.05
Rate for Payer: Humana Medicare Advantage	$194.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$188.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,906.54
Rate for Payer: Qualcare PPO/HMO/WC	$5,520.59
Rate for Payer: UnitedHealthcare Community & State	$886.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$188.35
Rate for Payer: Wellcare Medicare Advantage	$188.35
Rate for Payer: Wellpoint Medicaid Managed Care	$975.30

OCTREOTIDE 500 MCG/ML INJ

Facility

$991.40

Service Code	HCPCS J2354
Hospital Charge Code	60628854
Hospital Revenue Code	636
Min. Negotiated Rate	$148.71
Max. Negotiated Rate	$239.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.92
Rate for Payer: Qualcare PPO/HMO/WC	$148.71

OCTREOTIDE 500 MCG/ML INJ

Facility

$991.40

Service Code	HCPCS J2354
Hospital Charge Code	60628854
Hospital Revenue Code	636
Min. Negotiated Rate	$23.89
Max. Negotiated Rate	$495.70
Rate for Payer: Aetna Commercial	$376.73
Rate for Payer: Aetna Medicare Advantage	$297.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.81
Rate for Payer: Cigna Commercial	$495.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.92
Rate for Payer: Qualcare PPO/HMO/WC	$148.71
Rate for Payer: UnitedHealthcare Community & State	$23.89
Rate for Payer: Wellpoint Medicaid Managed Care	$26.27

OCTREOTIDE 50 MCG/ML INJ

Facility

$105.99

Service Code	HCPCS J2354
Hospital Charge Code	6010367
Hospital Revenue Code	636
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$52.99
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$52.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

OCTREOTIDE 50 MCG/ML INJ

Facility

$105.99

Service Code	HCPCS J2354
Hospital Charge Code	6010367
Hospital Revenue Code	636
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$25.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

OCULAR OCCLUDER

Facility

$47.00

Hospital Charge Code	270335238
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

OCULAR OCCLUDER

Facility

$47.00

Hospital Charge Code	270335238
Hospital Revenue Code	272
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

OCULAR OCCLUDER 36/BX

Facility

$16.05

Hospital Charge Code	270652844
Hospital Revenue Code	270
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.41

OCULAR OCCLUDER 36/BX

Facility

$16.05

Hospital Charge Code	270652844
Hospital Revenue Code	270
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.03
Rate for Payer: Aetna Commercial	$6.10
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.09
Rate for Payer: Cigna Commercial	$8.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.82
Rate for Payer: Oxford Commercial	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.41
Rate for Payer: UnitedHealthcare Commercial	$3.21
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

OCUPRESS 1%

Facility

$97.00

Hospital Charge Code	60635108
Hospital Revenue Code	250
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

OCUPRESS 1%

Facility

$97.00

Hospital Charge Code	60635108
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.10
Rate for Payer: Oxford Commercial	$19.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

OCUTRICIN HC OPHTH/3.5GM

Facility

$13.00

Hospital Charge Code	60633568
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

Know your out-of-pocket cost for care.

All Charges