Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

KETOROLAC 15 MG/ML INJ

Facility

$30.15

Service Code	HCPCS J1885
Hospital Charge Code	6006217
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.30
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Medicare Advantage	$0.40
Rate for Payer: Clover Medicare Advantage	$0.38
Rate for Payer: EmblemHealth Commercial	$1.20
Rate for Payer: Humana Medicare Advantage	$0.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.40
Rate for Payer: Wellcare Medicare Advantage	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

KETOROLAC 30 MG/ML INJ

Facility

$40.20

Service Code	HCPCS J1885
Hospital Charge Code	6006225
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$9.73
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Medicare Advantage	$0.40
Rate for Payer: Clover Medicare Advantage	$0.38
Rate for Payer: EmblemHealth Commercial	$1.20
Rate for Payer: Humana Medicare Advantage	$0.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.40
Rate for Payer: Wellcare Medicare Advantage	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

KETOROLAC 30 MG/ML INJ

Facility

$40.20

Service Code	HCPCS J1885
Hospital Charge Code	6006225
Hospital Revenue Code	636
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$9.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

KETOROLAC 30MG (TORADOL) VIAL

Facility

$7.00

Hospital Charge Code	83652573
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

KETOROLAC 30MG (TORADOL) VIAL

Facility

$7.00

Hospital Charge Code	83652573
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

KETOROLAC 60MG(TORADOL)VIAL

Facility

$15.00

Hospital Charge Code	83652575
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

KETOROLAC 60MG(TORADOL)VIAL

Facility

$15.00

Hospital Charge Code	83652575
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$3.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

KETOROLAC INJ 60MG/2ML

Facility

$50.25

Service Code	HCPCS J1885
Hospital Charge Code	60627689
Hospital Revenue Code	636
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$12.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.54

KETOROLAC INJ 60MG/2ML

Facility

$50.25

Service Code	HCPCS J1885
Hospital Charge Code	60627689
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$12.16
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Medicare Advantage	$0.40
Rate for Payer: Clover Medicare Advantage	$0.38
Rate for Payer: EmblemHealth Commercial	$1.20
Rate for Payer: Humana Medicare Advantage	$0.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.54
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.40
Rate for Payer: Wellcare Medicare Advantage	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

KETOROLAC TROM 0.5% OPTH

Facility

$326.49

Service Code	NDC 17478020919
Hospital Charge Code	60635778
Hospital Revenue Code	250
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$163.25
Rate for Payer: Aetna Commercial	$124.07
Rate for Payer: Aetna Medicare Advantage	$97.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.25
Rate for Payer: Cigna Commercial	$163.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.89
Rate for Payer: Oxford Commercial	$65.30
Rate for Payer: Qualcare PPO/HMO/WC	$48.97
Rate for Payer: UnitedHealthcare Commercial	$65.30
Rate for Payer: UnitedHealthcare Community & State	$10.32
Rate for Payer: Wellpoint Medicaid Managed Care	$9.27

KETOROLAC TROM 0.5% OPTH

Facility

$326.49

Service Code	NDC 17478020919
Hospital Charge Code	60635778
Hospital Revenue Code	250
Min. Negotiated Rate	$48.97
Max. Negotiated Rate	$48.97
Rate for Payer: Qualcare PPO/HMO/WC	$48.97

KETOSTEROIDS,17(17 KS)FRACTION

Facility

$303.00

Service Code	HCPCS 83593
Hospital Charge Code	38472110
Hospital Revenue Code	301
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

KETOSTEROIDS,17(17 KS)FRACTION

Facility

$303.00

Service Code	HCPCS 83593
Hospital Charge Code	38472110
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$92.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.50
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	$103.38
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: Cigna Medicare Advantage	$28.50
Rate for Payer: Clover Medicare Advantage	$27.07
Rate for Payer: EmblemHealth Commercial	$85.50
Rate for Payer: Humana Medicare Advantage	$29.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$22.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.50
Rate for Payer: Wellcare Medicare Advantage	$28.50
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

KEVZARA PFS 200MG/1.14ML

Facility

$13,989.60

Service Code	HCPCS C9399
Hospital Charge Code	606390315
Hospital Revenue Code	636
Min. Negotiated Rate	$397.30
Max. Negotiated Rate	$6,994.80
Rate for Payer: Aetna Commercial	$5,316.05
Rate for Payer: Aetna Medicare Advantage	$4,196.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,567.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,567.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,567.35
Rate for Payer: Cigna Commercial	$6,994.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,385.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,098.44
Rate for Payer: UnitedHealthcare Community & State	$442.07
Rate for Payer: Wellpoint Medicaid Managed Care	$397.30

KEVZARA PFS 200MG/1.14ML

Facility

$13,989.60

Service Code	HCPCS C9399
Hospital Charge Code	606390315
Hospital Revenue Code	636
Min. Negotiated Rate	$2,098.44
Max. Negotiated Rate	$3,385.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,385.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,098.44

KEY DILATOR TD-8/38

Facility

$336.00

Hospital Charge Code	270331220
Hospital Revenue Code	272
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$127.68
Rate for Payer: Aetna Medicare Advantage	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.68
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$67.20
Rate for Payer: UnitedHealthcare Community & State	$10.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.54

KEY DILATOR TD-8/38

Facility

$336.00

Hospital Charge Code	270331220
Hospital Revenue Code	272
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

KEYSTONE MULTI-STATE ECMO PACK

Facility

$1,127.95

Hospital Charge Code	2703110B
Hospital Revenue Code	272
Min. Negotiated Rate	$32.03
Max. Negotiated Rate	$563.98
Rate for Payer: Aetna Commercial	$428.62
Rate for Payer: Aetna Medicare Advantage	$338.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.63
Rate for Payer: Cigna Commercial	$563.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.27
Rate for Payer: Oxford Commercial	$225.59
Rate for Payer: Qualcare PPO/HMO/WC	$169.19
Rate for Payer: UnitedHealthcare Commercial	$225.59
Rate for Payer: UnitedHealthcare Community & State	$35.64
Rate for Payer: Wellpoint Medicaid Managed Care	$32.03

KEYSTONE MULTI-STATE ECMO PACK

Facility

$1,127.95

Hospital Charge Code	2703110B
Hospital Revenue Code	272
Min. Negotiated Rate	$169.19
Max. Negotiated Rate	$169.19
Rate for Payer: Qualcare PPO/HMO/WC	$169.19

KI-67 IHC

Facility

$1,082.30

Service Code	HCPCS 88360
Hospital Charge Code	401688360
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

KI-67 IHC

Facility

$1,082.30

Service Code	HCPCS 88360
Hospital Charge Code	401688360
Hospital Revenue Code	310
Min. Negotiated Rate	$30.74
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$97.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$30.74

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$77,280.87

Service Code	MSDRG 657
Min. Negotiated Rate	$23,531.03
Max. Negotiated Rate	$77,280.87
Rate for Payer: Aetna Commercial	$56,898.83
Rate for Payer: Aetna Medicare Advantage	$77,280.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50,977.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50,977.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,769.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50,977.20
Rate for Payer: Cigna Commercial	$40,796.19
Rate for Payer: Cigna Medicare Advantage	$24,769.51
Rate for Payer: Clover Medicare Advantage	$23,531.03
Rate for Payer: EmblemHealth Commercial	$74,308.53
Rate for Payer: Humana Medicare Advantage	$25,512.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,769.51
Rate for Payer: Oxford Commercial	$32,244.60
Rate for Payer: UnitedHealthcare Commercial	$43,160.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,769.51
Rate for Payer: Wellcare Medicare Advantage	$24,769.51

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$120,052.23

Service Code	MSDRG 656
Min. Negotiated Rate	$36,554.37
Max. Negotiated Rate	$120,052.23
Rate for Payer: Aetna Commercial	$87,361.07
Rate for Payer: Aetna Medicare Advantage	$120,052.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86,993.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86,993.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38,478.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86,993.70
Rate for Payer: Cigna Commercial	$70,976.45
Rate for Payer: Cigna Medicare Advantage	$38,478.28
Rate for Payer: Clover Medicare Advantage	$36,554.37
Rate for Payer: EmblemHealth Commercial	$115,434.84
Rate for Payer: Humana Medicare Advantage	$39,632.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38,478.28
Rate for Payer: Oxford Commercial	$56,098.56
Rate for Payer: UnitedHealthcare Commercial	$75,089.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$38,478.28
Rate for Payer: Wellcare Medicare Advantage	$38,478.28

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$68,491.52

Service Code	MSDRG 658
Min. Negotiated Rate	$20,854.79
Max. Negotiated Rate	$68,491.52
Rate for Payer: Aetna Commercial	$50,638.95
Rate for Payer: Aetna Medicare Advantage	$68,491.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,003.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,003.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,952.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,003.40
Rate for Payer: Cigna Commercial	$34,594.28
Rate for Payer: Cigna Medicare Advantage	$21,952.41
Rate for Payer: Clover Medicare Advantage	$20,854.79
Rate for Payer: EmblemHealth Commercial	$65,857.23
Rate for Payer: Humana Medicare Advantage	$22,610.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,952.41
Rate for Payer: Oxford Commercial	$27,342.72
Rate for Payer: UnitedHealthcare Commercial	$36,599.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,952.41
Rate for Payer: Wellcare Medicare Advantage	$21,952.41

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

$61,221.86

Service Code	MSDRG 660
Min. Negotiated Rate	$18,641.27
Max. Negotiated Rate	$61,221.86
Rate for Payer: Aetna Commercial	$45,461.43
Rate for Payer: Aetna Medicare Advantage	$61,221.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,401.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,401.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,622.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,401.75
Rate for Payer: Cigna Commercial	$29,464.66
Rate for Payer: Cigna Medicare Advantage	$19,622.39
Rate for Payer: Clover Medicare Advantage	$18,641.27
Rate for Payer: EmblemHealth Commercial	$58,867.17
Rate for Payer: Humana Medicare Advantage	$20,211.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,622.39
Rate for Payer: Oxford Commercial	$23,288.35
Rate for Payer: UnitedHealthcare Commercial	$31,172.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,622.39
Rate for Payer: Wellcare Medicare Advantage	$19,622.39

Know your out-of-pocket cost for care.

All Charges