Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MAGNESIUM SULFATE 2 GM/50 ML

Facility

$49.59

Hospital Charge Code	606380007
Hospital Revenue Code	636
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$24.80
Rate for Payer: Aetna Commercial	$18.84
Rate for Payer: Aetna Medicare Advantage	$14.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.65
Rate for Payer: Cigna Commercial	$24.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.44
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

MAGNESIUM SULFATE 2 GM/50 ML

Facility

$49.59

Hospital Charge Code	606380007
Hospital Revenue Code	636
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.44

MAGNESIUM SULFATE 4.00GM

Facility

$54.67

Service Code	HCPCS J3475
Hospital Charge Code	60635440
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.34
Rate for Payer: Aetna Commercial	$20.77
Rate for Payer: Aetna Medicare Advantage	$16.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.94
Rate for Payer: Cigna Commercial	$27.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.20
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

MAGNESIUM SULFATE 4.00GM

Facility

$54.67

Service Code	HCPCS J3475
Hospital Charge Code	60635440
Hospital Revenue Code	636
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$13.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.20

MAGNESIUM SULFATE,40GM

Facility

$5.00

Hospital Charge Code	60635441
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MAGNESIUM SULFATE,40GM

Facility

$5.00

Hospital Charge Code	60635441
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

MAGNESIUM SULFATE 50%/10G

Facility

$12.00

Hospital Charge Code	60634623
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

MAGNESIUM SULFATE 50%/10G

Facility

$12.00

Hospital Charge Code	60634623
Hospital Revenue Code	636
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

MAGNESIUM SULFATE 50%/1GM

Facility

$15.00

Hospital Charge Code	60633350
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

MAGNESIUM SULFATE 50%/1GM

Facility

$15.00

Hospital Charge Code	60633350
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
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
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

MAGNESIUM SULFATE GRANULES 4LB

Facility

$10.90

Hospital Charge Code	60628816
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

MAGNESIUM SULFATE GRANULES 4LB

Facility

$10.90

Hospital Charge Code	60628816
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

MAGNESIUM SULF IV 20GM 1000ML

Facility

$34.60

Hospital Charge Code	6010474
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

MAGNESIUM SULF IV 20GM 1000ML

Facility

$34.60

Hospital Charge Code	6010474
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

MAGNESIUM SULF IV 4GM 100ML

Facility

$1.95

Hospital Charge Code	6010482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

MAGNESIUM SULF IV 4GM 100ML

Facility

$1.95

Hospital Charge Code	6010482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

MAGNESIUM (URINE) 24 HR

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	3008208
Hospital Revenue Code	301
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.22
Rate for Payer: Aetna Medicare Advantage	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.18
Rate for Payer: Cigna Commercial	$99.95
Rate for Payer: Cigna Medicare Advantage	$6.70
Rate for Payer: Clover Medicare Advantage	$6.37
Rate for Payer: EmblemHealth Commercial	$20.10
Rate for Payer: Humana Medicare Advantage	$6.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.98
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Medicare Advantage	$6.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

MAGNESIUM (URINE) 24 HR

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	3008208
Hospital Revenue Code	301
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$29.98
Rate for Payer: Qualcare PPO/HMO/WC	$29.98

MAGNESIUM, URINE, RANDOM

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	3030822
Hospital Revenue Code	301
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$29.98
Rate for Payer: Qualcare PPO/HMO/WC	$29.98

MAGNESIUM, URINE, RANDOM

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	3030822
Hospital Revenue Code	301
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.22
Rate for Payer: Aetna Medicare Advantage	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.18
Rate for Payer: Cigna Commercial	$99.95
Rate for Payer: Cigna Medicare Advantage	$6.70
Rate for Payer: Clover Medicare Advantage	$6.37
Rate for Payer: EmblemHealth Commercial	$20.10
Rate for Payer: Humana Medicare Advantage	$6.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.98
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Medicare Advantage	$6.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

MAGNETIC IMG BONE MAROW-GL

Facility

$2,195.28

Service Code	HCPCS 77084
Hospital Charge Code	85000355
Hospital Revenue Code	614
Min. Negotiated Rate	$52.91
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$241.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.58
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$329.29
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$52.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$58.17

MAGNETIC IMG BONE MAROW-GL

Facility

$2,195.28

Service Code	HCPCS 77084
Hospital Charge Code	85000355
Hospital Revenue Code	614
Min. Negotiated Rate	$329.29
Max. Negotiated Rate	$329.29
Rate for Payer: Qualcare PPO/HMO/WC	$329.29

MAGNETIC IMG BONE MAROW-PC

Facility

$423.15

Service Code	HCPCS 7708426
Hospital Charge Code	85000365
Hospital Revenue Code	610
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$160.80
Rate for Payer: Aetna Medicare Advantage	$126.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.90
Rate for Payer: Cigna Commercial	$211.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.94
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.47
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$10.20
Rate for Payer: Wellpoint Medicaid Managed Care	$11.21

MAGNETIC IMG BONE MAROW-PC

Facility

$423.15

Service Code	HCPCS 7708426
Hospital Charge Code	85000365
Hospital Revenue Code	610
Min. Negotiated Rate	$63.47
Max. Negotiated Rate	$63.47
Rate for Payer: Qualcare PPO/HMO/WC	$63.47

MAGNETIC IMG BONE MAROW-TC

Facility

$2,006.10

Service Code	HCPCS 77084TC
Hospital Charge Code	85000360
Hospital Revenue Code	610
Min. Negotiated Rate	$300.92
Max. Negotiated Rate	$300.92
Rate for Payer: Qualcare PPO/HMO/WC	$300.92

Know your out-of-pocket cost for care.

All Charges