Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM ACT INJ 2.5MEQ/ML20M

Facility

$30.10

Hospital Charge Code	6004519
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

POTASSIUM ACT INJ 2.5MEQ/ML20M

Facility

$30.10

Hospital Charge Code	6004519
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.03
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

POTASSIUM ACT INJ 40MEQ/2ML

Facility

$15.40

Hospital Charge Code	60627919
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

POTASSIUM ACT INJ 40MEQ/2ML

Facility

$15.40

Hospital Charge Code	60627919
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

POTASSIUM BACARBONATE 25MEQ EF

Facility

$4.00

Service Code	NDC 904272046
Hospital Charge Code	6063943160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POTASSIUM BACARBONATE 25MEQ EF

Facility

$4.00

Service Code	NDC 904272046
Hospital Charge Code	6063943160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM BICARB TAB 25MEQ EFF

Facility

$4.00

Hospital Charge Code	60629029
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM BICARB TAB 25MEQ EFF

Facility

$4.00

Hospital Charge Code	60629029
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POTASSIUM BICARB TAB EFF 25MEQ

Facility

$3.20

Hospital Charge Code	60628686
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

POTASSIUM BICARB TAB EFF 25MEQ

Facility

$3.20

Hospital Charge Code	60627920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

POTASSIUM BICARB TAB EFF 25MEQ

Facility

$3.20

Hospital Charge Code	60627920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

POTASSIUM BICARB TAB EFF 25MEQ

Facility

$3.20

Hospital Charge Code	60628686
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

POTASSIUM (BLOOD OR URINE)***

Facility

$18.00

Hospital Charge Code	3012150
Hospital Revenue Code	309
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

POTASSIUM (BLOOD OR URINE)***

Facility

$18.00

Hospital Charge Code	3012150
Hospital Revenue Code	309
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

POTASSIUM CHL 20MEQ (D5W)

Facility

$32.90

Service Code	NDC 409790509
Hospital Charge Code	60627904
Hospital Revenue Code	258
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.45
Rate for Payer: Aetna Commercial	$12.50
Rate for Payer: Aetna Medicare Advantage	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.39
Rate for Payer: Cigna Commercial	$16.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.87
Rate for Payer: Oxford Commercial	$6.58
Rate for Payer: Qualcare PPO/HMO/WC	$4.93
Rate for Payer: UnitedHealthcare Commercial	$6.58
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

POTASSIUM CHL 20MEQ (D5W)

Facility

$32.90

Service Code	NDC 409790509
Hospital Charge Code	60627904
Hospital Revenue Code	258
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$4.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.93

POTASSIUM CHL 40MEQ (D5W)

Facility

$112.49

Service Code	NDC 409790609
Hospital Charge Code	60627905
Hospital Revenue Code	258
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$16.87
Rate for Payer: Qualcare PPO/HMO/WC	$16.87

POTASSIUM CHL 40MEQ (D5W)

Facility

$112.49

Service Code	NDC 409790609
Hospital Charge Code	60627905
Hospital Revenue Code	258
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$56.24
Rate for Payer: Aetna Commercial	$42.75
Rate for Payer: Aetna Medicare Advantage	$33.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.68
Rate for Payer: Cigna Commercial	$56.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.75
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.87
Rate for Payer: UnitedHealthcare Commercial	$22.50
Rate for Payer: UnitedHealthcare Community & State	$2.71
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

POTASSIUM CHL CAP 10MEQ

Facility

$1.95

Hospital Charge Code	6022750
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

POTASSIUM CHL CAP 10MEQ

Facility

$1.95

Hospital Charge Code	6022750
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

POTASSIUM CHL CAP SR 10MEQ

Facility

$2.85

Hospital Charge Code	60627921
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.43
Rate for Payer: Aetna Commercial	$1.08
Rate for Payer: Aetna Medicare Advantage	$0.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.73
Rate for Payer: Cigna Commercial	$1.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.86
Rate for Payer: Oxford Commercial	$0.57
Rate for Payer: Qualcare PPO/HMO/WC	$0.43
Rate for Payer: UnitedHealthcare Commercial	$0.57
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

POTASSIUM CHL CAP SR 10MEQ

Facility

$2.85

Hospital Charge Code	60627921
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Qualcare PPO/HMO/WC	$0.43

POTASSIUM CHL CAP SR 8MEQ

Facility

$4.00

Hospital Charge Code	60627929
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM CHL CAP SR 8MEQ

Facility

$4.00

Hospital Charge Code	60627929
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POTASSIUM CHL INJ 20MEQ/10ML

Facility

$8.04

Service Code	HCPCS J3480
Hospital Charge Code	60627923
Hospital Revenue Code	636
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

Know your out-of-pocket cost for care.

All Charges