St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OCTREOTIDE 1000 MCG/ML INJ

Facility

$338.00

Service Code	HCPCS J2354
Hospital Charge Code	41652980
Hospital Revenue Code	636
Min. Negotiated Rate	$169.00
Max. Negotiated Rate	$169.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.00
Rate for Payer: Hamaspik Choice Inc Medicare	$169.00

OCTREOTIDE 1000 MCG/ML INJ

Facility

$338.00

Service Code	HCPCS J2354
Hospital Charge Code	41652980
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$219.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$185.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$202.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.35
Rate for Payer: Group Health Inc Commercial	$169.00
Rate for Payer: Group Health Inc Medicare	$118.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.00
Rate for Payer: Hamaspik Choice Inc Medicare	$169.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.70

OCTREOTIDE 100 MCG/ML INJ

Facility

$1.49

Service Code	HCPCS J2354
Hospital Charge Code	41652982
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75

OCTREOTIDE 100 MCG/ML INJ

Facility

$1.49

Service Code	HCPCS J2354
Hospital Charge Code	41642982
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.97

OCTREOTIDE 100 MCG/ML INJ

Facility

$1.49

Service Code	HCPCS J2354
Hospital Charge Code	41642982
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75

OCTREOTIDE 100 MCG/ML INJ

Facility

$1.49

Service Code	HCPCS J2354
Hospital Charge Code	41652982
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.97

OCTREOTIDE 10 MCG/ML INJ NEONATAL

Facility

$3.00

Service Code	HCPCS J2354
Hospital Charge Code	41650689
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

OCTREOTIDE 10 MCG/ML INJ NEONATAL

Facility

$3.00

Service Code	HCPCS J2354
Hospital Charge Code	41640689
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

OCTREOTIDE 10 MCG/ML INJ NEONATAL

Facility

$3.00

Service Code	HCPCS J2354
Hospital Charge Code	41640689
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

OCTREOTIDE 10 MCG/ML INJ NEONATAL

Facility

$3.00

Service Code	HCPCS J2354
Hospital Charge Code	41650689
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

OCTREOTIDE 200 MCG/ML INJ

Facility

$18.00

Service Code	HCPCS J2354
Hospital Charge Code	41642978
Hospital Revenue Code	636
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00

OCTREOTIDE 200 MCG/ML INJ

Facility

$18.00

Service Code	HCPCS J2354
Hospital Charge Code	41652978
Hospital Revenue Code	636
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00

OCTREOTIDE 200 MCG/ML INJ

Facility

$18.00

Service Code	HCPCS J2354
Hospital Charge Code	41652978
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$11.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$10.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.35
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

OCTREOTIDE 200 MCG/ML INJ

Facility

$18.00

Service Code	HCPCS J2354
Hospital Charge Code	41642978
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$11.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$10.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.35
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

OCTREOTIDE 500 MCG/ML INJ

Facility

$1.40

Service Code	HCPCS J2354
Hospital Charge Code	41642983
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70
Rate for Payer: Hamaspik Choice Inc Medicare	$0.70

OCTREOTIDE 500 MCG/ML INJ

Facility

$1.40

Service Code	HCPCS J2354
Hospital Charge Code	41652983
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70
Rate for Payer: Hamaspik Choice Inc Medicare	$0.70

OCTREOTIDE 500 MCG/ML INJ

Facility

$1.40

Service Code	HCPCS J2354
Hospital Charge Code	41642983
Hospital Revenue Code	636
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: Group Health Inc Commercial	$0.70
Rate for Payer: Group Health Inc Medicare	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70
Rate for Payer: Hamaspik Choice Inc Medicare	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.91

OCTREOTIDE 500 MCG/ML INJ

Facility

$1.40

Service Code	HCPCS J2354
Hospital Charge Code	41652983
Hospital Revenue Code	636
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: Group Health Inc Commercial	$0.70
Rate for Payer: Group Health Inc Medicare	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70
Rate for Payer: Hamaspik Choice Inc Medicare	$0.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.91

OCTREOTIDE 50 MCG/ML INJ

Facility

$2.92

Service Code	HCPCS J2354
Hospital Charge Code	41653988
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46

OCTREOTIDE 50 MCG/ML INJ

Facility

$2.92

Service Code	HCPCS J2354
Hospital Charge Code	41653988
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.90

OCTREOTIDE 50 MCG/ML INJ

Facility

$2.92

Service Code	HCPCS J2354
Hospital Charge Code	41643988
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.19
Rate for Payer: SOMOS Essential	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.90

OCTREOTIDE 50 MCG/ML INJ

Facility

$2.92

Service Code	HCPCS J2354
Hospital Charge Code	41643988
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46

OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN [91279]

Facility

$11.93

Service Code	HCPCS J2354
Hospital Charge Code	63323037601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$9.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$8.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.11
Rate for Payer: Group Health Inc Commercial	$5.96
Rate for Payer: Group Health Inc Medicare	$4.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.96
Rate for Payer: Hamaspik Choice Inc Medicare	$5.96
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.19
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.19
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.75

OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN [91279]

Facility

$4.08

Service Code	HCPCS J2354
Hospital Charge Code	63323037604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.19
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.19
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.65

OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN [91279]

Facility

$32.86

Service Code	HCPCS J2354
Hospital Charge Code	00078018101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$26.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$24.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.34
Rate for Payer: Group Health Inc Commercial	$16.43
Rate for Payer: Group Health Inc Medicare	$11.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.43
Rate for Payer: Hamaspik Choice Inc Medicare	$16.43
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.19
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.19
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.36

Know your out-of-pocket cost for care.

All Charges