Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 1/MG INJ

Facility

$27.00

Hospital Charge Code	60634868
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

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	$1,627.35
Max. Negotiated Rate	$5,424.50
Rate for Payer: Aetna Commercial	$3,254.70
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

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	$5,214.38
Rate for Payer: Aetna Commercial	$3,128.62
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

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	$5,520.59
Max. Negotiated Rate	$11,041.17
Rate for Payer: Aetna Commercial	$11,041.17
Rate for Payer: Aetna Medicare Advantage	$11,041.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,384.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,384.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,384.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,906.54
Rate for Payer: Qualcare PPO/HMO/WC	$5,520.59

OCTREOTIDE 500 MCG/ML INJ

Facility

$991.40

Service Code	HCPCS J2354
Hospital Charge Code	60628854
Hospital Revenue Code	636
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$297.42
Rate for Payer: Aetna Commercial	$297.42
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	$0.62
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	$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 50 MCG/ML INJ

Facility

$105.99

Service Code	HCPCS J2354
Hospital Charge Code	6010367
Hospital Revenue Code	636
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$31.80
Rate for Payer: Aetna Commercial	$31.80
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	$0.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

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	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

OCULAR OCCLUDER

Facility

$47.00

Hospital Charge Code	270335238
Hospital Revenue Code	272
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$14.10
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	$6.11
Rate for Payer: Oxford Commercial	$23.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$23.50

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	$2.09
Max. Negotiated Rate	$8.03
Rate for Payer: Aetna Commercial	$4.82
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	$2.09
Rate for Payer: Oxford Commercial	$8.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.41
Rate for Payer: UnitedHealthcare Commercial	$8.03

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	$12.61
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial	$29.10
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	$12.61
Rate for Payer: Oxford Commercial	$48.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$48.50

OCUTRICIN HC OPHTH/3.5GM

Facility

$13.00

Hospital Charge Code	60633568
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

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

OCUTRICIN HC OPHTH/7.5ML

Facility

$28.00

Hospital Charge Code	60633567
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

OCUTRICIN HC OPHTH/7.5ML

Facility

$28.00

Hospital Charge Code	60633567
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

OCUVITE MULTIVIT W MINERLS TAB

Facility

$1.25

Hospital Charge Code	60629870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.19

OCUVITE MULTIVIT W MINERLS TAB

Facility

$1.25

Hospital Charge Code	60629870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.19
Rate for Payer: UnitedHealthcare Commercial	$0.63
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.32
Rate for Payer: Cigna Commercial	$0.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.16
Rate for Payer: Oxford Commercial	$0.63

Know your out-of-pocket cost for care.

All Charges