St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN

Facility

$17.88

Service Code	HCPCS J2354
Hospital Charge Code	6332337704
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$14.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$13.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.16
Rate for Payer: EmblemHealth Commercial	$8.94
Rate for Payer: Group Health Inc Commercial	$8.94
Rate for Payer: Group Health Inc Medicare	$6.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.94
Rate for Payer: Hamaspik Choice Inc Medicare	$8.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.62

OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN

Facility

$59.63

Service Code	HCPCS J2354
Hospital Charge Code	6332337700
Hospital Revenue Code	250
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$29.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.82

OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN

Facility

$59.63

Service Code	HCPCS J2354
Hospital Charge Code	6332337700
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$47.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$44.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.55
Rate for Payer: EmblemHealth Commercial	$29.82
Rate for Payer: Group Health Inc Commercial	$29.82
Rate for Payer: Group Health Inc Medicare	$20.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.82
Rate for Payer: Hamaspik Choice Inc Medicare	$29.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.76

OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN

Facility

$59.63

Service Code	HCPCS J2354
Hospital Charge Code	6332337701
Hospital Revenue Code	250
Min. Negotiated Rate	$29.81
Max. Negotiated Rate	$29.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.81

OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN

Facility

$59.63

Service Code	HCPCS J2354
Hospital Charge Code	6332337701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$47.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$44.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.55
Rate for Payer: EmblemHealth Commercial	$29.81
Rate for Payer: Group Health Inc Commercial	$29.81
Rate for Payer: Group Health Inc Medicare	$20.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.81
Rate for Payer: Hamaspik Choice Inc Medicare	$29.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.76

OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN

Facility

$43.75

Service Code	HCPCS J2354
Hospital Charge Code	6846289701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$35.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$32.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.75
Rate for Payer: EmblemHealth Commercial	$21.88
Rate for Payer: Group Health Inc Commercial	$21.88
Rate for Payer: Group Health Inc Medicare	$15.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.88
Rate for Payer: Hamaspik Choice Inc Medicare	$21.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.44

OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN

Facility

$17.88

Service Code	HCPCS J2354
Hospital Charge Code	6332337704
Hospital Revenue Code	250
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$8.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.94

OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN

Facility

$43.75

Service Code	HCPCS J2354
Hospital Charge Code	6846289701
Hospital Revenue Code	250
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$21.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.88

OCTREOTIDE ACETATE 50 MCG/ML SC SOSY

Facility

$4.80

Service Code	HCPCS J2354
Hospital Charge Code	6745723901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: EmblemHealth Commercial	$2.40
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

OCTREOTIDE ACETATE 50 MCG/ML SC SOSY

Facility

$4.80

Service Code	HCPCS J2354
Hospital Charge Code	6745723900
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: EmblemHealth Commercial	$2.40
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

OCTREOTIDE ACETATE 50 MCG/ML SC SOSY

Facility

$4.80

Service Code	HCPCS J2354
Hospital Charge Code	6745723901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40

OCTREOTIDE ACETATE 50 MCG/ML SC SOSY

Facility

$4.80

Service Code	HCPCS J2354
Hospital Charge Code	6745723900
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40

OCULAR AND PERIOCULAR MALIGNANCY

Facility

$173.57

Service Code	EAPG 00556
Min. Negotiated Rate	$173.57
Max. Negotiated Rate	$173.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$173.57

OCULAR IMAGING AND RELATED SERVICES

Facility

$131.92

Service Code	EAPG 00156
Min. Negotiated Rate	$131.92
Max. Negotiated Rate	$131.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$131.92

OFLOXACIN 0.3 % OP SOLN

Facility

$29.77

Service Code	NDC 1198077905
Hospital Charge Code	1198077905
Hospital Revenue Code	250
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$14.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.89

OFLOXACIN 0.3 % OP SOLN

Facility

$14.07

Service Code	NDC 6498051505
Hospital Charge Code	6498051505
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$7.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.04

OFLOXACIN 0.3 % OP SOLN

Facility

$14.07

Service Code	NDC 6498051505
Hospital Charge Code	6498051505
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$11.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.04
Rate for Payer: Aetna Government	$7.04
Rate for Payer: Brighton Health Commercial	$10.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.57
Rate for Payer: EmblemHealth Commercial	$7.04
Rate for Payer: Group Health Inc Commercial	$7.04
Rate for Payer: Group Health Inc Medicare	$4.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.04
Rate for Payer: Hamaspik Choice Inc Medicare	$7.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.15

OFLOXACIN 0.3 % OP SOLN

Facility

$4.19

Service Code	NDC 6050505600
Hospital Charge Code	6050505600
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.09
Rate for Payer: Aetna Government	$2.09
Rate for Payer: Brighton Health Commercial	$3.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.85
Rate for Payer: EmblemHealth Commercial	$2.09
Rate for Payer: Group Health Inc Commercial	$2.09
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.09
Rate for Payer: Hamaspik Choice Inc Medicare	$2.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.72

OFLOXACIN 0.3 % OP SOLN

Facility

$4.19

Service Code	NDC 6050505600
Hospital Charge Code	6050505600
Hospital Revenue Code	250
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.09

OFLOXACIN 0.3 % OP SOLN

Facility

$29.77

Service Code	NDC 1198077905
Hospital Charge Code	1198077905
Hospital Revenue Code	250
Min. Negotiated Rate	$10.42
Max. Negotiated Rate	$23.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.89
Rate for Payer: Aetna Government	$14.89
Rate for Payer: Brighton Health Commercial	$22.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.25
Rate for Payer: EmblemHealth Commercial	$14.89
Rate for Payer: Group Health Inc Commercial	$14.89
Rate for Payer: Group Health Inc Medicare	$10.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.89
Rate for Payer: Hamaspik Choice Inc Medicare	$14.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.35

OFLOXACIN 0.3 % OP SOLN

Facility

$14.07

Service Code	NDC 7075660730
Hospital Charge Code	7075660730
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$7.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.04

OFLOXACIN 0.3 % OP SOLN

Facility

$14.07

Service Code	NDC 7075660730
Hospital Charge Code	7075660730
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$11.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.04
Rate for Payer: Aetna Government	$7.04
Rate for Payer: Brighton Health Commercial	$10.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.57
Rate for Payer: EmblemHealth Commercial	$7.04
Rate for Payer: Group Health Inc Commercial	$7.04
Rate for Payer: Group Health Inc Medicare	$4.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.04
Rate for Payer: Hamaspik Choice Inc Medicare	$7.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.15

OFLOXACIN 0.3 % OT SOLN

Facility

$30.86

Service Code	NDC 6050503631
Hospital Charge Code	6050503631
Hospital Revenue Code	250
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$24.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.43
Rate for Payer: Aetna Government	$15.43
Rate for Payer: Brighton Health Commercial	$23.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.98
Rate for Payer: EmblemHealth Commercial	$15.43
Rate for Payer: Group Health Inc Commercial	$15.43
Rate for Payer: Group Health Inc Medicare	$10.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.43
Rate for Payer: Hamaspik Choice Inc Medicare	$15.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.06

OFLOXACIN 0.3 % OT SOLN

Facility

$30.86

Service Code	NDC 2420841005
Hospital Charge Code	2420841005
Hospital Revenue Code	250
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$24.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.43
Rate for Payer: Aetna Government	$15.43
Rate for Payer: Brighton Health Commercial	$23.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.98
Rate for Payer: EmblemHealth Commercial	$15.43
Rate for Payer: Group Health Inc Commercial	$15.43
Rate for Payer: Group Health Inc Medicare	$10.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.43
Rate for Payer: Hamaspik Choice Inc Medicare	$15.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.06

OFLOXACIN 0.3 % OT SOLN

Facility

$30.86

Service Code	NDC 2420841005
Hospital Charge Code	2420841005
Hospital Revenue Code	250
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$15.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.43

Know your out-of-pocket cost for care.

All Charges