Heights University Hospital

All Charges

Charge

Type

Setting

Price

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%/10G

Facility

$12.00

Hospital Charge Code	60634623
Hospital Revenue Code	636
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
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

MAGNESIUM SULFATE 50%/1GM

Facility

$15.00

Hospital Charge Code	60633350
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
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

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 GRANULES 4LB

Facility

$10.90

Hospital Charge Code	60628816
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
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	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

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	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
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	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

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	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
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	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

MAGNESIUM (URINE) 24 HR

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	3008208
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 (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	$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

MAGNETIC IMG BONE MAROW-GL

Facility

$2,195.28

Service Code	HCPCS 77084
Hospital Charge Code	85000355
Hospital Revenue Code	614
Min. Negotiated Rate	$232.89
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$658.58
Rate for Payer: Aetna Medicare Advantage	$658.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$559.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$559.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$559.80
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.39
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$329.29
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

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	$63.47
Max. Negotiated Rate	$63.47
Rate for Payer: Qualcare PPO/HMO/WC	$63.47

MAGNETIC IMG BONE MAROW-PC

Facility

$423.15

Service Code	HCPCS 7708426
Hospital Charge Code	85000365
Hospital Revenue Code	610
Min. Negotiated Rate	$55.01
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$126.94
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	$55.01
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.47
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

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

MAGNETIC IMG BONE MAROW-TC

Facility

$2,006.10

Service Code	HCPCS 77084TC
Hospital Charge Code	85000360
Hospital Revenue Code	610
Min. Negotiated Rate	$260.79
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$601.83
Rate for Payer: Aetna Medicare Advantage	$601.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.56
Rate for Payer: Cigna Commercial	$1,003.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.79
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.92
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MAGNETOS 1.5CC

Facility

$2,500.00

Hospital Charge Code	270703491
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

MAGNETOS 1.5CC

Facility

$2,500.00

Hospital Charge Code	270703491
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

MAGNET OS 2.5CC

Facility

$4,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270704883
Hospital Revenue Code	278
Min. Negotiated Rate	$607.50
Max. Negotiated Rate	$2,025.00
Rate for Payer: Aetna Commercial	$1,215.00
Rate for Payer: Aetna Medicare Advantage	$1,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,032.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,032.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,032.75
Rate for Payer: Cigna Commercial	$2,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$980.10
Rate for Payer: Qualcare PPO/HMO/WC	$607.50

MAGNET OS 2.5CC

Facility

$4,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270704883
Hospital Revenue Code	278
Min. Negotiated Rate	$607.50
Max. Negotiated Rate	$980.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$980.10
Rate for Payer: Qualcare PPO/HMO/WC	$607.50

MAGNUM 2 KNOTLESS IMPLANT

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270668401
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

Know your out-of-pocket cost for care.

All Charges