Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

KENALOG 40MG/ML VIAL 1ML

Facility

$11.00

Hospital Charge Code	83652571
Hospital Revenue Code	636
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

KENALOG 40MG/ML VIAL 1ML

Facility

$11.00

Hospital Charge Code	83652571
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

KEOTCONAZOLE 2% CREAM (15GM)

Facility

$879.91

Service Code	NDC 51672129801
Hospital Charge Code	606350980
Hospital Revenue Code	250
Min. Negotiated Rate	$24.99
Max. Negotiated Rate	$439.95
Rate for Payer: Aetna Commercial	$334.37
Rate for Payer: Aetna Medicare Advantage	$263.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.38
Rate for Payer: Cigna Commercial	$439.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.78
Rate for Payer: Oxford Commercial	$175.98
Rate for Payer: Qualcare PPO/HMO/WC	$131.99
Rate for Payer: UnitedHealthcare Commercial	$175.98
Rate for Payer: UnitedHealthcare Community & State	$27.81
Rate for Payer: Wellpoint Medicaid Managed Care	$24.99

KEOTCONAZOLE 2% CREAM (15GM)

Facility

$879.91

Service Code	NDC 51672129801
Hospital Charge Code	606350980
Hospital Revenue Code	250
Min. Negotiated Rate	$131.99
Max. Negotiated Rate	$131.99
Rate for Payer: Qualcare PPO/HMO/WC	$131.99

KEPPRA S/F LIQUID 473 ML

Facility

$22.71

Service Code	NDC 781614116
Hospital Charge Code	606350948
Hospital Revenue Code	250
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$3.41
Rate for Payer: Qualcare PPO/HMO/WC	$3.41

KEPPRA S/F LIQUID 473 ML

Facility

$22.71

Service Code	NDC 781614116
Hospital Charge Code	606350948
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.36
Rate for Payer: Aetna Commercial	$8.63
Rate for Payer: Aetna Medicare Advantage	$6.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.79
Rate for Payer: Cigna Commercial	$11.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.90
Rate for Payer: Oxford Commercial	$4.54
Rate for Payer: Qualcare PPO/HMO/WC	$3.41
Rate for Payer: UnitedHealthcare Commercial	$4.54
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

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	$0.38
Max. Negotiated Rate	$6.63
Rate for Payer: Aetna Commercial	$5.04
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
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

KETAMINE 10MG/1ML 20ML INJ

Facility

$132.66

Service Code	NDC 42023011310
Hospital Charge Code	60629284
Hospital Revenue Code	250
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$66.33
Rate for Payer: Aetna Commercial	$50.41
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	$34.49
Rate for Payer: Oxford Commercial	$26.53
Rate for Payer: Qualcare PPO/HMO/WC	$19.90
Rate for Payer: UnitedHealthcare Commercial	$26.53
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.77

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 200MG/20ML VIAL

Facility

$158.99

Service Code	NDC 65219018420
Hospital Charge Code	6063943400
Hospital Revenue Code	250
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$60.42
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	$41.34
Rate for Payer: Oxford Commercial	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$31.80
Rate for Payer: UnitedHealthcare Community & State	$5.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

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 30MG/3ML SYRINGE

Facility

$26.80

Service Code	NDC 69374098233
Hospital Charge Code	606390374
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
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	$6.97
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

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 INJ 500MG/10ML

Facility

$28.68

Service Code	NDC 409205310
Hospital Charge Code	60627670
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$14.34
Rate for Payer: Aetna Commercial	$10.90
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	$7.46
Rate for Payer: Oxford Commercial	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.30
Rate for Payer: UnitedHealthcare Commercial	$5.74
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

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

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	$5.29
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	$48.41
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	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

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	$0.60
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	$5.50
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	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

KETOGENIC STEROIDS,URINE

Facility

$207.00

Service Code	HCPCS 83582
Hospital Charge Code	38472431
Hospital Revenue Code	301
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$156.00
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	$56.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.12
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	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.12
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	$53.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$5.88

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

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	$16.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.40
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	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.40
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	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$18.96

KETOROLAC 15 MG/ML INJ

Facility

$30.15

Service Code	HCPCS J1885
Hospital Charge Code	6006217
Hospital Revenue Code	636
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$7.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

Know your out-of-pocket cost for care.

All Charges