Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MA DUCTOGRM/GALAC MULTI BILAT

Facility

$5,100.00

Service Code	HCPCS 77054
Hospital Charge Code	2700018
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

MA DUCTOGRM/GALACT SNGL BILAT

Facility

$5,100.00

Service Code	HCPCS 77053
Hospital Charge Code	2700019
Hospital Revenue Code	320
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$2,231.00
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	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
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	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
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	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

MA DUCTOGRM/GALACT SNGL BILAT

Facility

$5,100.00

Service Code	HCPCS 77053
Hospital Charge Code	2700019
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

MAG AB (IGM),EIA

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900528
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MAG AB (IGM),EIA

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900528
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MAG ANTIBODY, IGG

Facility

$509.00

Service Code	HCPCS 84182
Hospital Charge Code	38476235
Hospital Revenue Code	301
Min. Negotiated Rate	$76.35
Max. Negotiated Rate	$76.35
Rate for Payer: Qualcare PPO/HMO/WC	$76.35

MAG ANTIBODY, IGG

Facility

$509.00

Service Code	HCPCS 84182
Hospital Charge Code	38476235
Hospital Revenue Code	301
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$254.50
Rate for Payer: Aetna Commercial	$79.45
Rate for Payer: Aetna Medicare Advantage	$94.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.96
Rate for Payer: Cigna Commercial	$254.50
Rate for Payer: Cigna Medicare Advantage	$29.21
Rate for Payer: Clover Medicare Advantage	$27.75
Rate for Payer: EmblemHealth Commercial	$87.63
Rate for Payer: Humana Medicare Advantage	$30.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.34
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$23.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.21
Rate for Payer: Wellcare Medicare Advantage	$29.21
Rate for Payer: Wellpoint Medicaid Managed Care	$14.46

MAGNESIUM

Facility

$390.00

Service Code	HCPCS 83735
Hospital Charge Code	39990241E
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MAGNESIUM

Facility

$390.00

Service Code	HCPCS 83735
Hospital Charge Code	39990241E
Hospital Revenue Code	301
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$195.00
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	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.30
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	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.30
Rate for Payer: Cigna Commercial	$195.00
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	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$11.08

MAGNESIUM

Facility

$87.00

Service Code	HCPCS 83735
Hospital Charge Code	38479038
Hospital Revenue Code	301
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$156.00
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	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.30
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	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.30
Rate for Payer: Cigna Commercial	$43.50
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	$22.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$2.47

MAGNESIUM

Facility

$87.00

Service Code	HCPCS 83735
Hospital Charge Code	38479038
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

MAGNESIUM,24HRU

Facility

$87.00

Service Code	HCPCS 83735
Hospital Charge Code	38479036
Hospital Revenue Code	301
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$156.00
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	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.30
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	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.30
Rate for Payer: Cigna Commercial	$43.50
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	$22.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$2.47

MAGNESIUM,24HRU

Facility

$87.00

Service Code	HCPCS 83735
Hospital Charge Code	38479036
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

MAGNESIUM, 24 HR UR W/O C

Facility

$46.05

Service Code	HCPCS 83735
Hospital Charge Code	39900105
Hospital Revenue Code	301
Min. Negotiated Rate	$6.91
Max. Negotiated Rate	$6.91
Rate for Payer: Qualcare PPO/HMO/WC	$6.91

MAGNESIUM, 24 HR UR W/O C

Facility

$46.05

Service Code	HCPCS 83735
Hospital Charge Code	39900105
Hospital Revenue Code	301
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$156.00
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	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.30
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	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.30
Rate for Payer: Cigna Commercial	$23.02
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	$11.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.91
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$1.31

MAGNESIUM CHLORIDE 64 MG ER

Facility

$4.00

Service Code	NDC 68585000575
Hospital Charge Code	60627911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MAGNESIUM CHLORIDE 64 MG ER

Facility

$4.00

Service Code	NDC 68585000575
Hospital Charge Code	60627911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MAGNESIUM CHLORIDE ER 64MEQ TA

Facility

$4.00

Hospital Charge Code	6063943130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MAGNESIUM CHLORIDE ER 64MEQ TA

Facility

$4.00

Hospital Charge Code	6063943130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MAGNESIUM CITRATE SOL

Facility

$16.88

Service Code	NDC 24385067510
Hospital Charge Code	60628130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

MAGNESIUM CITRATE SOL

Facility

$16.88

Service Code	NDC 24385067510
Hospital Charge Code	60628130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.39
Rate for Payer: Oxford Commercial	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.38
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

MAGNESIUM HYDROXIDE SUSP. UD

Facility

$15.68

Service Code	NDC 121043130
Hospital Charge Code	60629315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$7.84
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna Medicare Advantage	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.00
Rate for Payer: Cigna Commercial	$7.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Oxford Commercial	$3.14
Rate for Payer: Qualcare PPO/HMO/WC	$2.35
Rate for Payer: UnitedHealthcare Commercial	$3.14
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

MAGNESIUM HYDROXIDE SUSP. UD

Facility

$15.68

Service Code	NDC 121043130
Hospital Charge Code	60629315
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.35

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 OXIDE 400 MG TAB UD

Facility

$4.00

Service Code	NDC 68585000641
Hospital Charge Code	60628913
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges