Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM CHL IVPB 10MEQ/100ML

Facility

$18.63

Service Code	HCPCS J3480
Hospital Charge Code	60628788
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
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	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

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	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.83

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

Facility

$30.35

Service Code	NDC 338067304
Hospital Charge Code	60628918
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
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	$7.89
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	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

POTASSIUM CHLORIDE

Facility

$4.00

Service Code	NDC 63323096520
Hospital Charge Code	60627927
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POTASSIUM CHLORIDE

Facility

$18.89

Service Code	NDC 338067104
Hospital Charge Code	60628525
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
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	$4.91
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	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

POTASSIUM CHLORIDE

Facility

$31.22

Service Code	NDC 338067504
Hospital Charge Code	60627902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
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	$8.12
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	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

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 8MEQ TAB

Facility

$4.42

Service Code	NDC 66758011013
Hospital Charge Code	6063943161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
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	$1.15
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	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

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 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	$0.55
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	$5.07
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	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

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/100 ML

Facility

$18.63

Service Code	HCPCS J3480
Hospital Charge Code	60628789
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
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	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

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	$1.94
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	$17.77
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	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.94

POTASSIUM CL SOL 20MEQ/15ML

Facility

$36.31

Service Code	NDC 121146515
Hospital Charge Code	60627925
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
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	$9.44
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	$1.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

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 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	$3.49
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	$31.98
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	$3.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

POTASSIUM NITRATE/SILV NIT SWB

Facility

$4.76

Service Code	NDC 54569235700
Hospital Charge Code	60630079
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
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	$1.24
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	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

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 PHOSPHATE

Facility

$33.50

Service Code	NDC 409729501
Hospital Charge Code	60627930
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
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	$8.71
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	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

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

Know your out-of-pocket cost for care.

All Charges