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All Charges

Charge

Type

Setting

Price

potassium chloride 20 mEq/15 mL Oral Liq [HMC]

Facility

IP

$39.00

Service Code	NDC 00904706187
Hospital Charge Code	3808561
Hospital Revenue Code	250
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$35.10
Rate for Payer: UnitedHealthcare Commercial	$37.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium chloride 20 mEq/15 mL Oral Liq [HMC]

Facility

OP

$55.10

Service Code	NDC 60687062871
Hospital Charge Code	3808561
Hospital Revenue Code	250
Min. Negotiated Rate	$22.04
Max. Negotiated Rate	$52.34
Rate for Payer: Aetna Commercial	$49.59
Rate for Payer: Humana Medicare Advantage	$23.14
Rate for Payer: UnitedHealthcare Commercial	$52.34
Rate for Payer: UnitedHealthcare Medicaid	$22.04
Rate for Payer: WPPA Medicare Advantage	$33.06

potassium chloride 20 mEq/15 mL Oral Liq [HMC]

Facility

OP

$32.63

Service Code	NDC 71656002101
Hospital Charge Code	3808561
Hospital Revenue Code	250
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$31.00
Rate for Payer: Aetna Commercial	$29.37
Rate for Payer: Humana Medicare Advantage	$13.70
Rate for Payer: UnitedHealthcare Commercial	$31.00
Rate for Payer: UnitedHealthcare Medicaid	$13.05
Rate for Payer: WPPA Medicare Advantage	$19.58

potassium chloride 20 mEq/15 mL Oral Liq [HMC]

Facility

IP

$55.10

Service Code	NDC 60687034171
Hospital Charge Code	3808561
Hospital Revenue Code	250
Min. Negotiated Rate	$49.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$49.59
Rate for Payer: UnitedHealthcare Commercial	$52.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium chloride 20 mEq/15 mL Oral Liq [HMC]

Facility

OP

$39.00

Service Code	NDC 00904706187
Hospital Charge Code	3808561
Hospital Revenue Code	250
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$37.05
Rate for Payer: Aetna Commercial	$35.10
Rate for Payer: Humana Medicare Advantage	$16.38
Rate for Payer: UnitedHealthcare Commercial	$37.05
Rate for Payer: UnitedHealthcare Medicaid	$15.60
Rate for Payer: WPPA Medicare Advantage	$23.40

potassium chloride 20 mEq/15 mL Oral Liq [HMC]

Facility

OP

$20.79

Service Code	NDC 00121146530
Hospital Charge Code	3808561
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna Commercial	$18.71
Rate for Payer: Humana Medicare Advantage	$8.73
Rate for Payer: UnitedHealthcare Commercial	$19.75
Rate for Payer: UnitedHealthcare Medicaid	$8.32
Rate for Payer: WPPA Medicare Advantage	$12.47

potassium chloride 20 mEq/15 mL Oral Liq [HMC]

Facility

IP

$55.10

Service Code	NDC 60687062871
Hospital Charge Code	3808561
Hospital Revenue Code	250
Min. Negotiated Rate	$49.59
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$49.59
Rate for Payer: UnitedHealthcare Commercial	$52.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium chloride 20 mEq/15 mL Oral Liq [HMC]

Facility

IP

$20.79

Service Code	NDC 00121146530
Hospital Charge Code	3808561
Hospital Revenue Code	250
Min. Negotiated Rate	$18.71
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.71
Rate for Payer: UnitedHealthcare Commercial	$19.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium chloride 2 mEq/mL IV Sol 10 mL [HMC]

Facility

OP

$21.00

Service Code	HCPCS J3480
Hospital Charge Code	3803324
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$19.95
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Humana Medicare Advantage	$8.82
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Medicaid	$0.12
Rate for Payer: WPPA Medicare Advantage	$12.60

potassium chloride 2 mEq/mL IV Sol 10 mL [HMC]

Facility

IP

$21.00

Service Code	HCPCS J3480
Hospital Charge Code	3803324
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium chloride 2 mEq/mL IV Sol [HMC]

Facility

IP

$37.86

Service Code	HCPCS J3480
Hospital Charge Code	3803324
Hospital Revenue Code	250
Min. Negotiated Rate	$34.07
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.07
Rate for Payer: UnitedHealthcare Commercial	$35.97
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium chloride 2 mEq/mL IV Sol [HMC]

Facility

OP

$37.86

Service Code	HCPCS J3480
Hospital Charge Code	3803324
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$35.97
Rate for Payer: Aetna Commercial	$34.07
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$0.15
Rate for Payer: Humana Medicare Advantage	$15.90
Rate for Payer: UnitedHealthcare Commercial	$35.97
Rate for Payer: UnitedHealthcare Medicaid	$0.12
Rate for Payer: WPPA Medicare Advantage	$22.72

Potassium Level

Facility

OP

$58.00

Service Code	HCPCS 84132
Hospital Charge Code	3550643
Hospital Revenue Code	300
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$55.10
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$9.87
Rate for Payer: Humana Medicare Advantage	$24.36
Rate for Payer: UnitedHealthcare Commercial	$55.10
Rate for Payer: UnitedHealthcare Medicaid	$4.20
Rate for Payer: WPPA Medicare Advantage	$34.80

Potassium Level

Facility

IP

$58.00

Service Code	HCPCS 84132
Hospital Charge Code	3550643
Hospital Revenue Code	300
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: UnitedHealthcare Commercial	$55.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium phosphate 3 mmol/mL (with potassium 4.4 mEq/mL) Sol [HMC]

Facility

IP

$55.49

Service Code	NDC 00409729501
Hospital Charge Code	3803340
Hospital Revenue Code	259
Min. Negotiated Rate	$49.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: UnitedHealthcare Commercial	$52.72
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium phosphate 3 mmol/mL (with potassium 4.4 mEq/mL) Sol [HMC]

Facility

OP

$55.49

Service Code	NDC 00409729501
Hospital Charge Code	3803340
Hospital Revenue Code	259
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$52.72
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Humana Medicare Advantage	$23.31
Rate for Payer: UnitedHealthcare Commercial	$52.72
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: WPPA Medicare Advantage	$33.29

potassium phosphate-sodium phosphate 250 mg-45 mg-298 mg Tab [HMC]

Facility

IP

$6.52

Service Code	NDC 64980010401
Hospital Charge Code	3804267
Hospital Revenue Code	250
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: UnitedHealthcare Commercial	$6.19
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium phosphate-sodium phosphate 250 mg-45 mg-298 mg Tab [HMC]

Facility

OP

$8.32

Service Code	NDC 68084076425
Hospital Charge Code	3804267
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$7.90
Rate for Payer: Aetna Commercial	$7.49
Rate for Payer: Humana Medicare Advantage	$3.49
Rate for Payer: UnitedHealthcare Commercial	$7.90
Rate for Payer: UnitedHealthcare Medicaid	$3.33
Rate for Payer: WPPA Medicare Advantage	$4.99

potassium phosphate-sodium phosphate 250 mg-45 mg-298 mg Tab [HMC]

Facility

IP

$7.66

Service Code	NDC 00486112501
Hospital Charge Code	3804267
Hospital Revenue Code	250
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.89
Rate for Payer: UnitedHealthcare Commercial	$7.28
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium phosphate-sodium phosphate 250 mg-45 mg-298 mg Tab [HMC]

Facility

IP

$8.32

Service Code	NDC 68084076425
Hospital Charge Code	3804267
Hospital Revenue Code	250
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.49
Rate for Payer: UnitedHealthcare Commercial	$7.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

potassium phosphate-sodium phosphate 250 mg-45 mg-298 mg Tab [HMC]

Facility

OP

$6.52

Service Code	NDC 64980010401
Hospital Charge Code	3804267
Hospital Revenue Code	250
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$6.19
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Humana Medicare Advantage	$2.74
Rate for Payer: UnitedHealthcare Commercial	$6.19
Rate for Payer: UnitedHealthcare Medicaid	$2.61
Rate for Payer: WPPA Medicare Advantage	$3.91

potassium phosphate-sodium phosphate 250 mg-45 mg-298 mg Tab [HMC]

Facility

OP

$7.66

Service Code	NDC 00486112501
Hospital Charge Code	3804267
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$7.28
Rate for Payer: Aetna Commercial	$6.89
Rate for Payer: Humana Medicare Advantage	$3.22
Rate for Payer: UnitedHealthcare Commercial	$7.28
Rate for Payer: UnitedHealthcare Medicaid	$3.06
Rate for Payer: WPPA Medicare Advantage	$4.60

Potassium, U w/o Creatinine QST

Facility

IP

$62.00

Service Code	HCPCS 84133
Hospital Charge Code	3558413
Hospital Revenue Code	300
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: UnitedHealthcare Commercial	$58.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Potassium, U w/o Creatinine QST

Facility

OP

$62.00

Service Code	HCPCS 84133
Hospital Charge Code	3558413
Hospital Revenue Code	300
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$58.90
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$19.96
Rate for Payer: Humana Medicare Advantage	$26.04
Rate for Payer: UnitedHealthcare Commercial	$58.90
Rate for Payer: UnitedHealthcare Medicaid	$4.20
Rate for Payer: WPPA Medicare Advantage	$37.20

Potato (f35) IgE QST

Facility

OP

$21.00

Service Code	HCPCS 86003
Hospital Charge Code	3552823
Hospital Revenue Code	300
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$19.95
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$15.51
Rate for Payer: Humana Medicare Advantage	$8.82
Rate for Payer: UnitedHealthcare Commercial	$19.95
Rate for Payer: UnitedHealthcare Medicaid	$5.22
Rate for Payer: WPPA Medicare Advantage	$12.60

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