Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM CHL INJ 20MEQ/10ML

Facility

$8.04

Service Code	HCPCS J3480
Hospital Charge Code	60627923
Hospital Revenue Code	636
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

POTASSIUM CHL INJ 40MEQ/20ML

Facility

$10.65

Service Code	HCPCS J3480
Hospital Charge Code	60627926
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.33
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna Medicare Advantage	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.72
Rate for Payer: Cigna Commercial	$5.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

POTASSIUM CHL INJ 40MEQ/20ML

Facility

$10.65

Service Code	HCPCS J3480
Hospital Charge Code	60627926
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.60

POTASSIUM CHL IVPB 10MEQ/100ML

Facility

$18.63

Service Code	HCPCS J3480
Hospital Charge Code	60628788
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.31
Rate for Payer: Aetna Commercial	$7.08
Rate for Payer: Aetna Medicare Advantage	$5.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.75
Rate for Payer: Cigna Commercial	$9.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.79
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

POTASSIUM CHL IVPB 10MEQ/100ML

Facility

$18.63

Service Code	HCPCS J3480
Hospital Charge Code	60628788
Hospital Revenue Code	636
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$4.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.79

POTASSIUM CHL IVPB 20MEQ/ 10ML

Facility

$7.70

Hospital Charge Code	60627924
Hospital Revenue Code	250
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

POTASSIUM CHL IVPB 20MEQ/ 10ML

Facility

$7.70

Hospital Charge Code	60627924
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

POTASSIUM CHL IVPB 40MEQ/100ML

Facility

$10.90

Hospital Charge Code	60628792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

POTASSIUM CHL IVPB 40MEQ/100ML

Facility

$10.90

Hospital Charge Code	60628792
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

POTASSIUM CHL LQ 20ME

Facility

$1.95

Hospital Charge Code	6022768
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 LQ 20ME

Facility

$1.95

Hospital Charge Code	6022768
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 LQ 40MEQ/30ML C

Facility

$3.20

Hospital Charge Code	6027171
Hospital Revenue Code	251
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 CHL LQ 40MEQ/30ML C

Facility

$3.20

Hospital Charge Code	6027171
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

POTASSIUM CHLOR 10MEQ/50ML BAG

Facility

$62.75

Hospital Charge Code	60629034
Hospital Revenue Code	250
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$9.41
Rate for Payer: Qualcare PPO/HMO/WC	$9.41

POTASSIUM CHLOR 10MEQ/50ML BAG

Facility

$62.75

Hospital Charge Code	60629034
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$31.38
Rate for Payer: Aetna Commercial	$23.84
Rate for Payer: Aetna Medicare Advantage	$18.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.00
Rate for Payer: Cigna Commercial	$31.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.82
Rate for Payer: Oxford Commercial	$12.55
Rate for Payer: Qualcare PPO/HMO/WC	$9.41
Rate for Payer: UnitedHealthcare Commercial	$12.55
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

POTASSIUM CHLORIDE

Facility

$31.22

Service Code	NDC 338067504
Hospital Charge Code	60627902
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$4.68
Rate for Payer: Qualcare PPO/HMO/WC	$4.68

POTASSIUM CHLORIDE

Facility

$18.89

Service Code	NDC 338067104
Hospital Charge Code	60628525
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.45
Rate for Payer: Aetna Commercial	$7.18
Rate for Payer: Aetna Medicare Advantage	$5.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.82
Rate for Payer: Cigna Commercial	$9.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.67
Rate for Payer: Oxford Commercial	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.83
Rate for Payer: UnitedHealthcare Commercial	$3.78
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

POTASSIUM CHLORIDE

Facility

$4.00

Service Code	NDC 63323096520
Hospital Charge Code	60627927
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 CHLORIDE

Facility

$4.00

Service Code	NDC 63323096520
Hospital Charge Code	60627927
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM CHLORIDE

Facility

$18.89

Service Code	NDC 338067104
Hospital Charge Code	60628525
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.83

POTASSIUM CHLORIDE

Facility

$31.22

Service Code	NDC 338067504
Hospital Charge Code	60627902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.61
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: Aetna Medicare Advantage	$9.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.96
Rate for Payer: Cigna Commercial	$15.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.37
Rate for Payer: Oxford Commercial	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$4.68
Rate for Payer: UnitedHealthcare Commercial	$6.24
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

POTASSIUM CHLORIDE

Facility

$30.35

Service Code	NDC 338067304
Hospital Charge Code	60628918
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.18
Rate for Payer: Aetna Commercial	$11.53
Rate for Payer: Aetna Medicare Advantage	$9.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.74
Rate for Payer: Cigna Commercial	$15.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.11
Rate for Payer: Oxford Commercial	$6.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.55
Rate for Payer: UnitedHealthcare Commercial	$6.07
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

POTASSIUM CHLORIDE

Facility

$30.35

Service Code	NDC 338067304
Hospital Charge Code	60628918
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.55

POTASSIUM CHLORIDE 10%/20

Facility

$15.00

Hospital Charge Code	60633695
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
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	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

POTASSIUM CHLORIDE 10%/20

Facility

$15.00

Hospital Charge Code	60633695
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

Know your out-of-pocket cost for care.

All Charges