Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM IODIDE LQ 100% 30ML

Facility

$53.80

Hospital Charge Code	6004535
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

POTASSIUM IODIDE LQ 100% 8OZ

Facility

$265.60

Hospital Charge Code	6004543
Hospital Revenue Code	251
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$39.84
Rate for Payer: Qualcare PPO/HMO/WC	$39.84

POTASSIUM IODIDE LQ 100% 8OZ

Facility

$265.60

Hospital Charge Code	6004543
Hospital Revenue Code	251
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$132.80
Rate for Payer: Aetna Commercial	$100.93
Rate for Payer: Aetna Medicare Advantage	$79.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.73
Rate for Payer: Cigna Commercial	$132.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.68
Rate for Payer: Oxford Commercial	$53.12
Rate for Payer: Qualcare PPO/HMO/WC	$39.84
Rate for Payer: UnitedHealthcare Commercial	$53.12
Rate for Payer: UnitedHealthcare Community & State	$6.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7.04

POTASSIUM NITRATE/SILV NIT SWB

Facility

$4.76

Service Code	NDC 54569235700
Hospital Charge Code	60630079
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$1.81
Rate for Payer: Aetna Medicare Advantage	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.21
Rate for Payer: Cigna Commercial	$2.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.43
Rate for Payer: Oxford Commercial	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.71
Rate for Payer: UnitedHealthcare Commercial	$0.95
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

POTASSIUM NITRATE/SILV NIT SWB

Facility

$4.76

Service Code	NDC 54569235700
Hospital Charge Code	60630079
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.71

POTASSIUM PHOSPH 15ML/66MEGK+

Facility

$10.90

Hospital Charge Code	6009047
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

POTASSIUM PHOSPH 15ML/66MEGK+

Facility

$10.90

Hospital Charge Code	6009047
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 PHOSPHATE

Facility

$33.50

Service Code	NDC 409729501
Hospital Charge Code	60627930
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.03

POTASSIUM PHOSPHATE

Facility

$33.50

Service Code	NDC 409729501
Hospital Charge Code	60627930
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.75
Rate for Payer: Aetna Commercial	$12.73
Rate for Payer: Aetna Medicare Advantage	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.54
Rate for Payer: Cigna Commercial	$16.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.05
Rate for Payer: Oxford Commercial	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.03
Rate for Payer: UnitedHealthcare Commercial	$6.70
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

POTASSIUM PHOSPHATE, MONOBAS 5

Facility

$4.00

Service Code	NDC 486111105
Hospital Charge Code	6063943269
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM PHOSPHATE, MONOBAS 5

Facility

$4.00

Service Code	NDC 486111105
Hospital Charge Code	6063943269
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 PHOSPH INJ 5ML

Facility

$7.25

Hospital Charge Code	60627931
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

POTASSIUM PHOSPH INJ 5ML

Facility

$7.25

Hospital Charge Code	60627931
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

POTASSIUM, PLASMA

Facility

$45.25

Service Code	HCPCS 84132
Hospital Charge Code	3008943
Hospital Revenue Code	301
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna Medicare Advantage	$15.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.18
Rate for Payer: Cigna Commercial	$22.62
Rate for Payer: Cigna Medicare Advantage	$4.76
Rate for Payer: Clover Medicare Advantage	$4.52
Rate for Payer: EmblemHealth Commercial	$14.28
Rate for Payer: Humana Medicare Advantage	$4.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.79
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.76
Rate for Payer: Wellcare Medicare Advantage	$4.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

POTASSIUM, PLASMA

Facility

$45.25

Service Code	HCPCS 84132
Hospital Charge Code	3008943
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$6.79
Rate for Payer: Qualcare PPO/HMO/WC	$6.79

POTASSIUM, SERUM

Facility

$390.00

Service Code	HCPCS 84132
Hospital Charge Code	3002151
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

POTASSIUM, SERUM

Facility

$390.00

Service Code	HCPCS 84132
Hospital Charge Code	3002151
Hospital Revenue Code	301
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna Medicare Advantage	$15.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.18
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.76
Rate for Payer: Clover Medicare Advantage	$4.52
Rate for Payer: EmblemHealth Commercial	$14.28
Rate for Payer: Humana Medicare Advantage	$4.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.76
Rate for Payer: Wellcare Medicare Advantage	$4.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

POTASSIUM,SERUM K

Facility

$117.00

Service Code	HCPCS 84132
Hospital Charge Code	38472551
Hospital Revenue Code	301
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna Medicare Advantage	$15.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.18
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: Cigna Medicare Advantage	$4.76
Rate for Payer: Clover Medicare Advantage	$4.52
Rate for Payer: EmblemHealth Commercial	$14.28
Rate for Payer: Humana Medicare Advantage	$4.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.76
Rate for Payer: Wellcare Medicare Advantage	$4.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

POTASSIUM,SERUM K

Facility

$117.00

Service Code	HCPCS 84132
Hospital Charge Code	38472551
Hospital Revenue Code	301
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

POTASSIUM, SERUM PANEL***

Facility

$59.00

Service Code	HCPCS 84702
Hospital Charge Code	3002151P
Hospital Revenue Code	301
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.33
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

POTASSIUM, SERUM PANEL***

Facility

$59.00

Service Code	HCPCS 84702
Hospital Charge Code	3002151P
Hospital Revenue Code	301
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

POTASSIUM SODIUM CITRATE SOL

Facility

$30.15

Service Code	NDC 60258000216
Hospital Charge Code	60627886
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare Advantage	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.69
Rate for Payer: Cigna Commercial	$15.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: Oxford Commercial	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

POTASSIUM SODIUM CITRATE SOL

Facility

$30.15

Service Code	NDC 60258000216
Hospital Charge Code	60627886
Hospital Revenue Code	250
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

POTASSIUM SODIUM PHOSPH POWD

Facility

$4.00

Service Code	NDC 60258000601
Hospital Charge Code	60627932
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 SODIUM PHOSPH POWD

Facility

$4.00

Service Code	NDC 60258000601
Hospital Charge Code	60627932
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges