Heights University Hospital

All Charges

Charge

Type

Setting

Price

KETAMINE 100MG 5ML VIAL

Facility

$13.27

Service Code	NDC 42023011510
Hospital Charge Code	6064943023
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$3.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.99

KETAMINE 100MG 5ML VIAL

Facility

$13.27

Service Code	NDC 42023011510
Hospital Charge Code	6064943023
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$6.63
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna Medicare Advantage	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.38
Rate for Payer: Cigna Commercial	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.99

KETAMINE 10MG/1ML 20ML INJ

Facility

$132.66

Service Code	NDC 42023011310
Hospital Charge Code	60629284
Hospital Revenue Code	250
Min. Negotiated Rate	$19.90
Max. Negotiated Rate	$19.90
Rate for Payer: Qualcare PPO/HMO/WC	$19.90

KETAMINE 10MG/1ML 20ML INJ

Facility

$132.66

Service Code	NDC 42023011310
Hospital Charge Code	60629284
Hospital Revenue Code	250
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$66.33
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna Medicare Advantage	$39.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.83
Rate for Payer: Cigna Commercial	$66.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.25
Rate for Payer: Oxford Commercial	$66.33
Rate for Payer: Qualcare PPO/HMO/WC	$19.90
Rate for Payer: UnitedHealthcare Commercial	$66.33

KETAMINE 200MG/20ML VIAL

Facility

$158.99

Service Code	NDC 65219018420
Hospital Charge Code	6063943400
Hospital Revenue Code	250
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

KETAMINE 200MG/20ML VIAL

Facility

$158.99

Service Code	NDC 65219018420
Hospital Charge Code	6063943400
Hospital Revenue Code	250
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.54
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.67
Rate for Payer: Oxford Commercial	$79.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$79.50

KETAMINE 30MG/3ML SYRINGE

Facility

$26.80

Service Code	NDC 69374098233
Hospital Charge Code	606390374
Hospital Revenue Code	250
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.48
Rate for Payer: Oxford Commercial	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$13.40

KETAMINE 30MG/3ML SYRINGE

Facility

$26.80

Service Code	NDC 69374098233
Hospital Charge Code	606390374
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

KETAMINE 50MG/ML

Facility

$19.92

Hospital Charge Code	60635817
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$9.96
Rate for Payer: Aetna Commercial	$5.98
Rate for Payer: Aetna Medicare Advantage	$5.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.08
Rate for Payer: Cigna Commercial	$9.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.59
Rate for Payer: Oxford Commercial	$9.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.99
Rate for Payer: UnitedHealthcare Commercial	$9.96

KETAMINE 50MG/ML

Facility

$19.92

Hospital Charge Code	60635817
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Qualcare PPO/HMO/WC	$2.99

KETAMINE 50MG/ML SYRINGE

Facility

$16.20

Hospital Charge Code	60635770
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.43

KETAMINE 50MG/ML SYRINGE

Facility

$16.20

Hospital Charge Code	60635770
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: Aetna Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.13
Rate for Payer: Cigna Commercial	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.11
Rate for Payer: Oxford Commercial	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.43
Rate for Payer: UnitedHealthcare Commercial	$8.10

KETAMINE INJ 10MG

Facility

$70.40

Hospital Charge Code	6009146
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$21.12
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$35.20

KETAMINE INJ 10MG

Facility

$70.40

Hospital Charge Code	6009146
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

KETAMINE INJ 500MG/10ML

Facility

$28.68

Service Code	NDC 409205310
Hospital Charge Code	60627670
Hospital Revenue Code	250
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$4.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.30

KETAMINE INJ 500MG/10ML

Facility

$28.68

Service Code	NDC 409205310
Hospital Charge Code	60627670
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$14.34
Rate for Payer: Aetna Commercial	$8.60
Rate for Payer: Aetna Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.31
Rate for Payer: Cigna Commercial	$14.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.73
Rate for Payer: Oxford Commercial	$14.34
Rate for Payer: Qualcare PPO/HMO/WC	$4.30
Rate for Payer: UnitedHealthcare Commercial	$14.34

KETAMINE INJ 50MG

Facility

$143.40

Hospital Charge Code	6009153
Hospital Revenue Code	250
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$71.70
Rate for Payer: Aetna Commercial	$43.02
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	$18.64
Rate for Payer: Oxford Commercial	$71.70
Rate for Payer: Qualcare PPO/HMO/WC	$21.51
Rate for Payer: UnitedHealthcare Commercial	$71.70

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/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	$9.49
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$21.90
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	$9.49
Rate for Payer: Oxford Commercial	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$36.50

KETOCONAZOLE 1 BOTTLE SHAMPOO

Facility

$186.19

Service Code	NDC 45802046564
Hospital Charge Code	60628339
Hospital Revenue Code	250
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$93.09
Rate for Payer: Aetna Commercial	$55.86
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	$24.20
Rate for Payer: Oxford Commercial	$93.09
Rate for Payer: Qualcare PPO/HMO/WC	$27.93
Rate for Payer: UnitedHealthcare Commercial	$93.09

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 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	$2.75
Max. Negotiated Rate	$10.59
Rate for Payer: Aetna Commercial	$6.35
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	$2.75
Rate for Payer: Oxford Commercial	$10.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.18
Rate for Payer: UnitedHealthcare Commercial	$10.59

KETOCONAZOLE CRM 30GM

Facility

$185.00

Hospital Charge Code	6007363
Hospital Revenue Code	252
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$55.50
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	$24.05
Rate for Payer: Oxford Commercial	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$92.50

Know your out-of-pocket cost for care.

All Charges