Heights University Hospital

All Charges

Charge

Type

Setting

Price

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 10%/20

Facility

$15.00

Hospital Charge Code	60633695
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
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

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

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/2MEQ/1

Facility

$6.00

Hospital Charge Code	60633694
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
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

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	$0.57
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.33
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	$0.57
Rate for Payer: Oxford Commercial	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$2.21

POTASSIUM CHL TAB 20MG

Facility

$3.85

Hospital Charge Code	6024145
Hospital Revenue Code	251
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
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	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

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	$2.54
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Commercial	$5.85
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	$2.54
Rate for Payer: Oxford Commercial	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.92
Rate for Payer: UnitedHealthcare Commercial	$9.75

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 CHL VL 40MEQ

Facility

$3.20

Hospital Charge Code	6022776
Hospital Revenue Code	251
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
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	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

POTASSIUM CL 10 MEQ/50 ML

Facility

$4.00

Hospital Charge Code	60628847
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

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	$0.13
Max. Negotiated Rate	$5.59
Rate for Payer: Cigna Commercial	$0.13
Rate for Payer: Aetna Commercial	$5.59
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: MagnaCare PPO/Direct Plus/Exchange/WC	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.79

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	$8.88
Max. Negotiated Rate	$34.17
Rate for Payer: Aetna Commercial	$20.50
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	$8.88
Rate for Payer: Oxford Commercial	$34.17
Rate for Payer: Qualcare PPO/HMO/WC	$10.25
Rate for Payer: UnitedHealthcare Commercial	$34.17

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 30 MEQ/100 ML

Facility

$13.65

Hospital Charge Code	60628791
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
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	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

POTASSIUM CL 40 MEQ/100 ML

Facility

$13.65

Hospital Charge Code	60628790
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
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	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

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	$4.72
Max. Negotiated Rate	$18.16
Rate for Payer: Aetna Commercial	$10.89
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	$4.72
Rate for Payer: Oxford Commercial	$18.16
Rate for Payer: Qualcare PPO/HMO/WC	$5.45
Rate for Payer: UnitedHealthcare Commercial	$18.16

Know your out-of-pocket cost for care.

All Charges