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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]

Facility

IP

$38.12

Service Code	NDC 0085-4331-01
Hospital Charge Code	NDG2211
Hospital Revenue Code	250
Min. Negotiated Rate	$20.97
Max. Negotiated Rate	$30.50
Rate for Payer: Cash Price	$17.15
Rate for Payer: Cigna of CA HMO/PPO	$30.50
Rate for Payer: Health Smart Auto/Commercial	$22.87
Rate for Payer: LLUH Dept of Risk Management WC	$20.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.59

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

IP

$0.21

Service Code	NDC 0409-8183-11
Hospital Charge Code	NDG6420A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

IP

$0.21

Service Code	NDC 0409-8183-01
Hospital Charge Code	NDG6420A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

IP

$0.26

Service Code	NDC 0409-3294-51
Hospital Charge Code	NDG6420B
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

IP

$0.26

Service Code	NDC 51754-2004-1
Hospital Charge Code	ERX6420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

OP

$0.21

Service Code	NDC 0409-8183-11
Hospital Charge Code	NDG6420A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

OP

$0.26

Service Code	NDC 0409-3294-61
Hospital Charge Code	NDG6420B
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

OP

$0.26

Service Code	NDC 51754-2004-1
Hospital Charge Code	ERX6420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

OP

$0.26

Service Code	NDC 0409-3294-51
Hospital Charge Code	NDG6420B
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.16
Rate for Payer: Aetna of CA Government/Medicare	$0.16
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

IP

$0.26

Service Code	NDC 0409-3294-61
Hospital Charge Code	NDG6420B
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.21
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.20

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

OP

$0.32

Service Code	NDC 51754-2001-4
Hospital Charge Code	NDG6420A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.24

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

IP

$0.32

Service Code	NDC 51754-2001-4
Hospital Charge Code	NDG6420A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.26
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.26
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.24

POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]

Facility

OP

$0.21

Service Code	NDC 0409-8183-01
Hospital Charge Code	NDG6420A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.16

POTASSIUM ACETATE ORAL SOLUTION (IV FORM) 2 MEQ/ML [4080437]

Facility

IP

$0.03

Service Code	NDC 9994-0804-37
Hospital Charge Code	1715970
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of CA HMO/PPO	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

POTASSIUM ACETATE ORAL SOLUTION (IV FORM) 2 MEQ/ML [4080437]

Facility

OP

$0.03

Service Code	NDC 9994-0804-37
Hospital Charge Code	1715970
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.02

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

OP

$1.04

Service Code	NDC 66689-048-30
Hospital Charge Code	1716014
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.47
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

OP

$0.85

Service Code	NDC 66689-048-50
Hospital Charge Code	1716014
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

IP

$0.15

Service Code	NDC 69238-1459-2
Hospital Charge Code	1715493
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA HMO/PPO	$0.12
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

IP

$1.04

Service Code	NDC 66689-048-30
Hospital Charge Code	1716014
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.83
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cigna of CA HMO/PPO	$0.83
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

OP

$0.47

Service Code	NDC 9999-6432-02
Hospital Charge Code	1716022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

OP

$0.15

Service Code	NDC 69238-1459-2
Hospital Charge Code	1715493
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.09
Rate for Payer: Aetna of CA Government/Medicare	$0.09
Rate for Payer: Cash Price	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

OP

$0.85

Service Code	NDC 66689-048-01
Hospital Charge Code	1716014
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

IP

$0.47

Service Code	NDC 9999-6432-03
Hospital Charge Code	1716014
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

IP

$0.85

Service Code	NDC 66689-048-50
Hospital Charge Code	1716014
Hospital Revenue Code	259
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna of CA HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.64

POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]

Facility

IP

$0.47

Service Code	NDC 9999-6432-02
Hospital Charge Code	1716022
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.38
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.38
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.26
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.35

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