Heights University Hospital

All Charges

Charge

Type

Setting

Price

MAGNESIUM OXIDE

Facility

$1.00

Hospital Charge Code	60634438
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

MAGNESIUM OXIDE 400 MG TAB UD

Facility

$4.00

Service Code	NDC 68585000641
Hospital Charge Code	60628913
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

MAGNESIUM OXIDE 400 MG TAB UD

Facility

$4.00

Service Code	NDC 68585000641
Hospital Charge Code	60628913
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MAGNESIUM RBC

Facility

$87.00

Service Code	HCPCS 83735
Hospital Charge Code	38472473
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

MAGNESIUM RBC

Facility

$87.00

Service Code	HCPCS 83735
Hospital Charge Code	38472473
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.71
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.55
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	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.55
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: Cigna Medicare Advantage	$3.35
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: MagnaCare PPO/Direct Plus/Exchange/WC	$11.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.10
Rate for Payer: Wellcare Medicare Advantage	$6.70

MAGNESIUM, RBC

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	3030825
Hospital Revenue Code	301
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$29.98
Rate for Payer: Qualcare PPO/HMO/WC	$29.98

MAGNESIUM, RBC

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	3030825
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.71
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.55
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	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.55
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: Cigna Medicare Advantage	$3.35
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: MagnaCare PPO/Direct Plus/Exchange/WC	$25.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.98
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.10
Rate for Payer: Wellcare Medicare Advantage	$6.70

MAGNESIUM, SERUM

Facility

$659.50

Service Code	HCPCS 83735
Hospital Charge Code	3001872
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.71
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.55
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	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.55
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: Cigna Medicare Advantage	$3.35
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: MagnaCare PPO/Direct Plus/Exchange/WC	$85.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.92
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.10
Rate for Payer: Wellcare Medicare Advantage	$6.70

MAGNESIUM, SERUM

Facility

$659.50

Service Code	HCPCS 83735
Hospital Charge Code	3001872
Hospital Revenue Code	301
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$98.92
Rate for Payer: Qualcare PPO/HMO/WC	$98.92

MAGNESIUM SERUM PANEL

Facility

$28.60

Service Code	HCPCS 83735
Hospital Charge Code	3001872P
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.71
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.55
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	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.55
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: Cigna Medicare Advantage	$3.35
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: MagnaCare PPO/Direct Plus/Exchange/WC	$3.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.29
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.10
Rate for Payer: Wellcare Medicare Advantage	$6.70

MAGNESIUM SERUM PANEL

Facility

$28.60

Service Code	HCPCS 83735
Hospital Charge Code	3001872P
Hospital Revenue Code	301
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$4.29
Rate for Payer: Qualcare PPO/HMO/WC	$4.29

MAGNESIUM SULF 50% L/S

Facility

$19.00

Hospital Charge Code	60635715
Hospital Revenue Code	636
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$4.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

MAGNESIUM SULF 50% L/S

Facility

$19.00

Hospital Charge Code	60635715
Hospital Revenue Code	636
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

MAGNESIUM SULFATE,1.000MG

Facility

$5.00

Hospital Charge Code	60635439
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,1.000MG

Facility

$5.00

Hospital Charge Code	60635439
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
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

MAGNESIUMSULFATE 1GM/100ML D5W

Facility

$50.38

Service Code	HCPCS J3475
Hospital Charge Code	60628639
Hospital Revenue Code	636
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$12.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$7.56

MAGNESIUMSULFATE 1GM/100ML D5W

Facility

$50.38

Service Code	HCPCS J3475
Hospital Charge Code	60628639
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$15.11
Rate for Payer: Aetna Commercial	$15.11
Rate for Payer: Aetna Medicare Advantage	$15.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.85
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$7.56

MAGNESIUM SULFATE 2G 50ML PREM

Facility

$93.53

Service Code	NDC 409523960
Hospital Charge Code	606351016
Hospital Revenue Code	250
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$46.77
Rate for Payer: Aetna Commercial	$28.06
Rate for Payer: Aetna Medicare Advantage	$28.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.85
Rate for Payer: Cigna Commercial	$46.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.16
Rate for Payer: Oxford Commercial	$46.77
Rate for Payer: Qualcare PPO/HMO/WC	$14.03
Rate for Payer: UnitedHealthcare Commercial	$46.77

MAGNESIUM SULFATE 2G 50ML PREM

Facility

$93.53

Service Code	NDC 409523960
Hospital Charge Code	606351016
Hospital Revenue Code	250
Min. Negotiated Rate	$14.03
Max. Negotiated Rate	$14.03
Rate for Payer: Qualcare PPO/HMO/WC	$14.03

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 2 GM/50 ML

Facility

$49.59

Hospital Charge Code	606380007
Hospital Revenue Code	636
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$24.80
Rate for Payer: Aetna Commercial	$14.88
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

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 4.00GM

Facility

$54.67

Service Code	HCPCS J3475
Hospital Charge Code	60635440
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$16.40
Rate for Payer: Aetna Commercial	$16.40
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	$0.43
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	$0.75
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
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

Know your out-of-pocket cost for care.

All Charges