|
CORTISOL, URINARY FREE
|
Facility
|
IP
|
$139.25
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3009214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|
|
CORTISOL, URINARY FREE
|
Facility
|
OP
|
$139.25
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3009214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$54.14
|
| Rate for Payer: Aetna Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.23
|
| Rate for Payer: Cigna Commercial |
$16.71
|
| Rate for Payer: Cigna Medicare Advantage |
$8.36
|
| Rate for Payer: Clover Medicare Advantage |
$15.87
|
| Rate for Payer: EmblemHealth Commercial |
$50.13
|
| Rate for Payer: Humana Medicare Advantage |
$17.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.71
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$17.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.71
|
|
|
CORTISONE 25 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 143120201
|
| Hospital Charge Code |
60628183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
CORTISONE 25 MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 143120201
|
| Hospital Charge Code |
60628183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| 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 |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
CORTISONE ACETATE INJ 50MG/ML
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS J0810
|
| Hospital Charge Code |
6001374
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.10
|
|
|
CORTISONE ACETATE INJ 50MG/ML
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J0810
|
| Hospital Charge Code |
6001374
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.77
|
| Rate for Payer: Cigna Commercial |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Oxford Commercial |
$27.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.00
|
|
|
CORTISPORIN
|
Facility
|
IP
|
$152.35
|
|
| Hospital Charge Code |
6008387
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.85
|
|
|
CORTISPORIN
|
Facility
|
OP
|
$152.35
|
|
| Hospital Charge Code |
6008387
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$76.17 |
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Medicare Advantage |
$45.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.85
|
| Rate for Payer: Cigna Commercial |
$76.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.81
|
| Rate for Payer: Oxford Commercial |
$76.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.17
|
|
|
CORTISPORIN/15GM
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
60632747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.45
|
|
|
CORTISPORIN/15GM
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
60632747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$41.50 |
| Rate for Payer: Aetna Commercial |
$24.90
|
| Rate for Payer: Aetna Medicare Advantage |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.16
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.79
|
| Rate for Payer: Oxford Commercial |
$41.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.50
|
|
|
CORTISPORIN/7.5GM
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
60632748
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Medicare Advantage |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.12
|
| Rate for Payer: Cigna Commercial |
$37.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.75
|
| Rate for Payer: Oxford Commercial |
$37.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$37.50
|
|
|
CORTISPORIN/7.5GM
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
60632748
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
|
|
CORTISPORIN OPHTH/3.5GM
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
60632749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.45
|
|
|
CORTISPORIN OPHTH/3.5GM
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
60632749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$41.50 |
| Rate for Payer: Aetna Commercial |
$24.90
|
| Rate for Payer: Aetna Medicare Advantage |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.16
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.79
|
| Rate for Payer: Oxford Commercial |
$41.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.50
|
|
|
CORTISPORIN OTIC/10ML
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
60632751
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
|
|
CORTISPORIN OTIC/10ML
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
60632751
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$31.20
|
| Rate for Payer: Aetna Medicare Advantage |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.52
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.52
|
| Rate for Payer: Oxford Commercial |
$52.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.00
|
|
|
CORTISPORIN OTIC/10ML
|
Facility
|
IP
|
$674.56
|
|
|
Service Code
|
NDC 61314064610
|
| Hospital Charge Code |
60632752
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$101.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.18
|
|
|
CORTISPORIN OTIC/10ML
|
Facility
|
OP
|
$674.56
|
|
|
Service Code
|
NDC 61314064610
|
| Hospital Charge Code |
60632752
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$337.28 |
| Rate for Payer: Aetna Commercial |
$202.37
|
| Rate for Payer: Aetna Medicare Advantage |
$202.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.01
|
| Rate for Payer: Cigna Commercial |
$337.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.69
|
| Rate for Payer: Oxford Commercial |
$337.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$337.28
|
|
|
CORTISPORIN SOL
|
Facility
|
OP
|
$125.45
|
|
| Hospital Charge Code |
6008411
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$62.73 |
| Rate for Payer: Aetna Commercial |
$37.63
|
| Rate for Payer: Aetna Medicare Advantage |
$37.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.99
|
| Rate for Payer: Cigna Commercial |
$62.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.31
|
| Rate for Payer: Oxford Commercial |
$62.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.73
|
|
|
CORTISPORIN SOL
|
Facility
|
IP
|
$125.45
|
|
| Hospital Charge Code |
6008411
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.82
|
|
|
CORTISPORIN UNG OINT
|
Facility
|
OP
|
$125.45
|
|
| Hospital Charge Code |
6008429
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$62.73 |
| Rate for Payer: Aetna Commercial |
$37.63
|
| Rate for Payer: Aetna Medicare Advantage |
$37.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.99
|
| Rate for Payer: Cigna Commercial |
$62.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.31
|
| Rate for Payer: Oxford Commercial |
$62.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.73
|
|
|
CORTISPORIN UNG OINT
|
Facility
|
IP
|
$125.45
|
|
| Hospital Charge Code |
6008429
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.82
|
|
|
CORTONE/25MG/TAB
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
60634362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
CORTONE/25MG/TAB
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
60634362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| 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 |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
CORTOSS CARTRIDGE 10 CC
|
Facility
|
IP
|
$7,500.00
|
|
| Hospital Charge Code |
2709006357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,125.00
|
|