Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM CHLORIDE/2MEQ/1

Facility

$6.00

Hospital Charge Code	60633694
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

POTASSIUM CHLORIDE/2MEQ/1

Facility

$6.00

Hospital Charge Code	60633694
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

POTASSIUM CHLORIDE 8MEQ TAB

Facility

$4.42

Service Code	NDC 66758011013
Hospital Charge Code	6063943161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

POTASSIUM CHLORIDE 8MEQ TAB

Facility

$4.42

Service Code	NDC 66758011013
Hospital Charge Code	6063943161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$0.88
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

POTASSIUM CHL TAB 20MG

Facility

$3.85

Hospital Charge Code	6024145
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

POTASSIUM CHL TAB 20MG

Facility

$3.85

Hospital Charge Code	6024145
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

POTASSIUM CHL TAB SR 20MEQ

Facility

$19.50

Service Code	NDC 68084036001
Hospital Charge Code	60627922
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.92

POTASSIUM CHL TAB SR 20MEQ

Facility

$19.50

Service Code	NDC 68084036001
Hospital Charge Code	60627922
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Commercial	$7.41
Rate for Payer: Aetna Medicare Advantage	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.97
Rate for Payer: Cigna Commercial	$9.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.92
Rate for Payer: UnitedHealthcare Commercial	$3.90
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

POTASSIUM CHL VL 40MEQ

Facility

$3.20

Hospital Charge Code	6022776
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 VL 40MEQ

Facility

$3.20

Hospital Charge Code	6022776
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

POTASSIUM CL 10 MEQ/50 ML

Facility

$4.00

Hospital Charge Code	60628847
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 CL 10 MEQ/50 ML

Facility

$4.00

Hospital Charge Code	60628847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM CL 20 MEQ/100 ML

Facility

$18.63

Service Code	HCPCS J3480
Hospital Charge Code	60628789
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 CL 20 MEQ/100 ML

Facility

$18.63

Service Code	HCPCS J3480
Hospital Charge Code	60628789
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 CL 20 MEQ PACKET

Facility

$68.34

Service Code	NDC 43386019431
Hospital Charge Code	606390433
Hospital Revenue Code	250
Min. Negotiated Rate	$10.25
Max. Negotiated Rate	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$10.25

POTASSIUM CL 20 MEQ PACKET

Facility

$68.34

Service Code	NDC 43386019431
Hospital Charge Code	606390433
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$34.17
Rate for Payer: Aetna Commercial	$25.97
Rate for Payer: Aetna Medicare Advantage	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.43
Rate for Payer: Cigna Commercial	$34.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.50
Rate for Payer: Oxford Commercial	$13.67
Rate for Payer: Qualcare PPO/HMO/WC	$10.25
Rate for Payer: UnitedHealthcare Commercial	$13.67
Rate for Payer: UnitedHealthcare Community & State	$1.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1.81

POTASSIUM CL 30 MEQ/100 ML

Facility

$13.65

Hospital Charge Code	60628791
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

POTASSIUM CL 30 MEQ/100 ML

Facility

$13.65

Hospital Charge Code	60628791
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

POTASSIUM CL 40 MEQ/100 ML

Facility

$13.65

Hospital Charge Code	60628790
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

POTASSIUM CL 40 MEQ/100 ML

Facility

$13.65

Hospital Charge Code	60628790
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

POTASSIUM CL SOL 20MEQ/15ML

Facility

$36.31

Service Code	NDC 121146515
Hospital Charge Code	60627925
Hospital Revenue Code	250
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$5.45

POTASSIUM CL SOL 20MEQ/15ML

Facility

$36.31

Service Code	NDC 121146515
Hospital Charge Code	60627925
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.16
Rate for Payer: Aetna Commercial	$13.80
Rate for Payer: Aetna Medicare Advantage	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.26
Rate for Payer: Cigna Commercial	$18.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Oxford Commercial	$7.26
Rate for Payer: Qualcare PPO/HMO/WC	$5.45
Rate for Payer: UnitedHealthcare Commercial	$7.26
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

POTASSIUM HYDROXIDE 1N (235ML)

Facility

$123.00

Hospital Charge Code	270331771
Hospital Revenue Code	272
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

POTASSIUM HYDROXIDE 1N (235ML)

Facility

$123.00

Hospital Charge Code	270331771
Hospital Revenue Code	272
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna Commercial	$46.74
Rate for Payer: Aetna Medicare Advantage	$36.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.36
Rate for Payer: Cigna Commercial	$61.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.90
Rate for Payer: Oxford Commercial	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Commercial	$24.60
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

POTASSIUM IODIDE LQ 100% 30ML

Facility

$53.80

Hospital Charge Code	6004535
Hospital Revenue Code	251
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

Know your out-of-pocket cost for care.

All Charges