St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MA BREAST SPECIMEN

Facility

$1,458.58

Service Code	HCPCS 76098 TC
Hospital Charge Code	41102660
Hospital Revenue Code	320
Min. Negotiated Rate	$446.58
Max. Negotiated Rate	$814.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$802.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$637.97
Rate for Payer: Aetna Government	$637.97
Rate for Payer: Affinity Essential Plan 1&2	$446.58
Rate for Payer: Affinity Essential Plan 3&4	$446.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$446.58
Rate for Payer: Brighton Health Commercial	$637.97
Rate for Payer: Cash Price	$637.97
Rate for Payer: Cash Price	$637.97
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$637.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$814.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$689.45
Rate for Payer: Elderplan Medicare Advantage	$637.97
Rate for Payer: EmblemHealth Commercial	$446.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$542.27
Rate for Payer: Fidelis Essential Plan Aliesa	$542.27
Rate for Payer: Fidelis Essential Plan QHP	$567.79
Rate for Payer: Fidelis Medicare Advantage	$637.97
Rate for Payer: Fidelis Qualified Health Plan	$567.79
Rate for Payer: Group Health Inc Commercial	$574.17
Rate for Payer: Group Health Inc Medicare	$574.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.29
Rate for Payer: Hamaspik Choice Inc Medicare	$637.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$574.17
Rate for Payer: Healthfirst Medicare Advantage	$637.97
Rate for Payer: Healthfirst QHP	$637.97
Rate for Payer: Humana Medicare	$650.73
Rate for Payer: Senior Whole Health Medicare Advantage	$637.97
Rate for Payer: United Healthcare Medicare Advantage	$637.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$637.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$510.38
Rate for Payer: Wellcare Medicare	$606.07

MAC 3 BLADE DISPOS

Facility

$31.25

Hospital Charge Code	64905961
Hospital Revenue Code	270
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$25.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.62
Rate for Payer: Aetna Government	$15.62
Rate for Payer: Brighton Health Commercial	$23.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.25
Rate for Payer: Group Health Inc Commercial	$15.62
Rate for Payer: Group Health Inc Medicare	$10.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.62
Rate for Payer: Hamaspik Choice Inc Medicare	$15.62

MA CONSULTATION MAMMO FILMS

Facility

$81.19

Service Code	HCPCS 76140
Hospital Charge Code	41108707
Hospital Revenue Code	320
Min. Negotiated Rate	$28.42
Max. Negotiated Rate	$64.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.92
Rate for Payer: Aetna Government	$59.92
Rate for Payer: Brighton Health Commercial	$60.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.21
Rate for Payer: Group Health Inc Commercial	$40.60
Rate for Payer: Group Health Inc Medicare	$28.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.60
Rate for Payer: Hamaspik Choice Inc Medicare	$40.60

MACRO DRIP 10 DROP 2 SITES

Facility

$6.03

Hospital Charge Code	40509808
Hospital Revenue Code	260
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02
Rate for Payer: United Healthcare Commercial	$76.00

MACRO DRIP SET CONTINUFLO

Facility

$9.22

Hospital Charge Code	40509797
Hospital Revenue Code	260
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$6.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.27
Rate for Payer: Group Health Inc Commercial	$4.61
Rate for Payer: Group Health Inc Medicare	$3.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.61
Rate for Payer: Hamaspik Choice Inc Medicare	$4.61
Rate for Payer: United Healthcare Commercial	$76.00

MACROPROLACTIN

Facility

$48.45

Service Code	HCPCS 84146
Hospital Charge Code	40609862
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.38

MACROPROLACTIN

Facility

$48.45

Service Code	HCPCS 84146
Hospital Charge Code	40609862
Hospital Revenue Code	301
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$36.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.38
Rate for Payer: Aetna Government	$19.38
Rate for Payer: Affinity Essential Plan 1&2	$13.57
Rate for Payer: Affinity Essential Plan 3&4	$13.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.57
Rate for Payer: Brighton Health Commercial	$36.34
Rate for Payer: Cash Price	$19.38
Rate for Payer: Cash Price	$19.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.07
Rate for Payer: Elderplan Medicare Advantage	$19.38
Rate for Payer: EmblemHealth Commercial	$19.38
Rate for Payer: Fidelis Essential Plan Aliesa	$16.47
Rate for Payer: Fidelis Essential Plan QHP	$17.25
Rate for Payer: Fidelis Medicare Advantage	$19.38
Rate for Payer: Fidelis Qualified Health Plan	$17.25
Rate for Payer: Group Health Inc Commercial	$19.38
Rate for Payer: Group Health Inc Medicare	$19.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.22
Rate for Payer: Hamaspik Choice Inc Medicare	$19.38
Rate for Payer: Healthfirst Medicare Advantage	$19.38
Rate for Payer: Healthfirst QHP	$19.38
Rate for Payer: Humana Medicare	$19.77
Rate for Payer: Senior Whole Health Medicare Advantage	$19.38
Rate for Payer: United Healthcare Commercial	$24.54
Rate for Payer: United Healthcare Medicare Advantage	$19.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.50
Rate for Payer: Wellcare Medicare	$17.44

MAGIC MOUTHWASH - COMPOUNDED (LIDO/BENADRYL/MAALOX) [700875]

Facility

$0.19

Service Code	NDC 09999123466
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN [4711]

Facility

$0.01

Service Code	NDC 00904678744
Hospital Charge Code	00904678744
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MAGNESIUM CITRATE LIQUID

Facility

$3.00

Hospital Charge Code	41640063
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

MAGNESIUM CITRATE LIQUID

Facility

$3.00

Hospital Charge Code	41650063
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

MAGNESIUM HYDROXIDE 2400 MG/10ML PO SUSP [99693]

Facility

$0.35

Service Code	NDC 00121094010
Hospital Charge Code	00121094010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

MAGNESIUM HYDROXIDE 2400 MG/10ML PO SUSP [99693]

Facility

$0.35

Service Code	NDC 00121094000
Hospital Charge Code	00121094000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP [28836]

Facility

$0.09

Service Code	NDC 69339015317
Hospital Charge Code	69339015317
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP [28836]

Facility

$0.08

Service Code	NDC 00121043130
Hospital Charge Code	00121043130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

MAGNESIUM HYDROXIDE CONC SUSP 10 ML

Facility

$0.52

Hospital Charge Code	41643496
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

MAGNESIUM HYDROXIDE CONC SUSP 10 ML

Facility

$0.52

Hospital Charge Code	41653496
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

MAGNESIUM OXIDE 400 MG TAB

Facility

$1.00

Hospital Charge Code	41640331
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MAGNESIUM OXIDE 400 MG TAB

Facility

$1.00

Hospital Charge Code	41650331
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS [117539]

Facility

$0.09

Service Code	NDC 64980033912
Hospital Charge Code	64980033912
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS [117539]

Facility

$0.09

Service Code	NDC 69543021712
Hospital Charge Code	69543021712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

MAGNESIUM SERUM

Facility

$16.75

Service Code	HCPCS 83735
Hospital Charge Code	40602185
Hospital Revenue Code	301
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$12.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.70
Rate for Payer: Aetna Government	$6.70
Rate for Payer: Affinity Essential Plan 1&2	$4.69
Rate for Payer: Affinity Essential Plan 3&4	$4.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.69
Rate for Payer: Brighton Health Commercial	$12.56
Rate for Payer: Cash Price	$6.70
Rate for Payer: Cash Price	$6.70
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.02
Rate for Payer: Elderplan Medicare Advantage	$6.70
Rate for Payer: EmblemHealth Commercial	$6.70
Rate for Payer: Fidelis Essential Plan Aliesa	$5.70
Rate for Payer: Fidelis Essential Plan QHP	$5.96
Rate for Payer: Fidelis Medicare Advantage	$6.70
Rate for Payer: Fidelis Qualified Health Plan	$5.96
Rate for Payer: Group Health Inc Commercial	$6.70
Rate for Payer: Group Health Inc Medicare	$6.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.38
Rate for Payer: Hamaspik Choice Inc Medicare	$6.70
Rate for Payer: Healthfirst Medicare Advantage	$6.70
Rate for Payer: Healthfirst QHP	$6.70
Rate for Payer: Humana Medicare	$6.83
Rate for Payer: Senior Whole Health Medicare Advantage	$6.70
Rate for Payer: United Healthcare Commercial	$8.49
Rate for Payer: United Healthcare Medicare Advantage	$6.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.36
Rate for Payer: Wellcare Medicare	$6.03

MAGNESIUM SERUM

Facility

$16.75

Service Code	HCPCS 83735
Hospital Charge Code	40602185
Hospital Revenue Code	301
Rate for Payer: Cash Price	$6.70

MAGNESIUM SULFATE 1 GRAM/100 ML PREMIX

Facility

$6.24

Service Code	HCPCS J3475
Hospital Charge Code	41644281
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$4.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$3.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.59
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.68
Rate for Payer: SOMOS Essential	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

MAGNESIUM SULFATE 1 GRAM/100 ML PREMIX

Facility

$6.24

Service Code	HCPCS J3475
Hospital Charge Code	41654281
Hospital Revenue Code	636
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12

Know your out-of-pocket cost for care.

All Charges