Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KETAMINE INJ 50MG

Facility

$143.40

Hospital Charge Code	6009153
Hospital Revenue Code	250
Min. Negotiated Rate	$21.51
Max. Negotiated Rate	$21.51
Rate for Payer: Qualcare PPO/HMO/WC	$21.51

KETAMINE INJ 50MG

Facility

$143.40

Hospital Charge Code	6009153
Hospital Revenue Code	250
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$71.70
Rate for Payer: Aetna Commercial	$54.49
Rate for Payer: Aetna Medicare Advantage	$43.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.57
Rate for Payer: Cigna Commercial	$71.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.02
Rate for Payer: Oxford Commercial	$28.68
Rate for Payer: Qualcare PPO/HMO/WC	$21.51
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Community & State	$3.46
Rate for Payer: Wellpoint Medicaid Managed Care	$3.80

KETAMINE INJ 50MG/ML,10ML VIAL

Facility

$73.00

Hospital Charge Code	6007553
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

KETAMINE INJ 50MG/ML,10ML VIAL

Facility

$73.00

Hospital Charge Code	6007553
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

KETOCONAZOLE 1 BOTTLE SHAMPOO

Facility

$186.19

Service Code	NDC 45802046564
Hospital Charge Code	60628339
Hospital Revenue Code	250
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$27.93
Rate for Payer: Qualcare PPO/HMO/WC	$27.93

KETOCONAZOLE 1 BOTTLE SHAMPOO

Facility

$186.19

Service Code	NDC 45802046564
Hospital Charge Code	60628339
Hospital Revenue Code	250
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$93.09
Rate for Payer: Aetna Commercial	$70.75
Rate for Payer: Aetna Medicare Advantage	$55.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.48
Rate for Payer: Cigna Commercial	$93.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.86
Rate for Payer: Oxford Commercial	$37.24
Rate for Payer: Qualcare PPO/HMO/WC	$27.93
Rate for Payer: UnitedHealthcare Commercial	$37.24
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

KETOCONAZOLE 200 MG TAB

Facility

$21.17

Service Code	NDC 51672402606
Hospital Charge Code	60628840
Hospital Revenue Code	250
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$3.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.18

KETOCONAZOLE 200 MG TAB

Facility

$21.17

Service Code	NDC 51672402606
Hospital Charge Code	60628840
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.59
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.40
Rate for Payer: Cigna Commercial	$10.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.35
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.18
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

KETOCONAZOLE CRM 30GM

Facility

$185.00

Hospital Charge Code	6007363
Hospital Revenue Code	252
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Oxford Commercial	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$37.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

KETOCONAZOLE CRM 30GM

Facility

$185.00

Hospital Charge Code	6007363
Hospital Revenue Code	252
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

KETOCONAZOLE TAB 200MG

Facility

$19.85

Hospital Charge Code	6003206
Hospital Revenue Code	252
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

KETOCONAZOLE TAB 200MG

Facility

$19.85

Hospital Charge Code	6003206
Hospital Revenue Code	252
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

KETO-DIASTIX 50 TEST BOTTLE

Facility

$7.70

Hospital Charge Code	6009740
Hospital Revenue Code	259
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

KETO-DIASTIX 50 TEST BOTTLE

Facility

$7.70

Hospital Charge Code	6009740
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

KETOGENIC STEROIDS,URINE

Facility

$207.00

Service Code	HCPCS 83582
Hospital Charge Code	38472431
Hospital Revenue Code	301
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.08
Rate for Payer: Aetna Medicare Advantage	$50.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.84
Rate for Payer: Cigna Commercial	$103.50
Rate for Payer: Cigna Medicare Advantage	$15.47
Rate for Payer: Clover Medicare Advantage	$14.70
Rate for Payer: EmblemHealth Commercial	$46.41
Rate for Payer: Humana Medicare Advantage	$15.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.47
Rate for Payer: Wellcare Medicare Advantage	$15.47
Rate for Payer: Wellpoint Medicaid Managed Care	$5.49

KETOGENIC STEROIDS,URINE

Facility

$207.00

Service Code	HCPCS 83582
Hospital Charge Code	38472431
Hospital Revenue Code	301
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$31.05

KETONE BODIES, PLASMA

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3035123C
Hospital Revenue Code	307
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare Advantage	$26.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.49
Rate for Payer: Cigna Commercial	$13.95
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Medicare Advantage	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

KETONE BODIES, PLASMA

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3035123A
Hospital Revenue Code	307
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare Advantage	$26.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.49
Rate for Payer: Cigna Commercial	$13.95
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Medicare Advantage	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

KETONE BODIES, PLASMA

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3035123A
Hospital Revenue Code	307
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

KETONE BODIES, PLASMA

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3035123C
Hospital Revenue Code	307
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

KETONE BODIES, PLASMA

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3035123B
Hospital Revenue Code	307
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare Advantage	$26.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.49
Rate for Payer: Cigna Commercial	$13.95
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Medicare Advantage	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

KETONE BODIES, PLASMA

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3035123B
Hospital Revenue Code	307
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

KETONES -ACETONES

Facility

$667.59

Service Code	HCPCS 82009
Hospital Charge Code	38472434
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

KETONES -ACETONES

Facility

$667.59

Service Code	HCPCS 82009
Hospital Charge Code	38472434
Hospital Revenue Code	301
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$12.29
Rate for Payer: Aetna Medicare Advantage	$14.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$4.52
Rate for Payer: Clover Medicare Advantage	$4.29
Rate for Payer: EmblemHealth Commercial	$13.56
Rate for Payer: Humana Medicare Advantage	$4.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.52
Rate for Payer: Wellcare Medicare Advantage	$4.52
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

KETONES (URINE)****

Facility

$21.00

Hospital Charge Code	3010048
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

Know your out-of-pocket cost for care.

All Charges