St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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	41644281
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

MAGNESIUM SULFATE 1 GRAM/2 ML INJ

Facility

$0.84

Service Code	HCPCS J3475
Hospital Charge Code	41650124
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42

MAGNESIUM SULFATE 1 GRAM/2 ML INJ

Facility

$0.84

Service Code	HCPCS J3475
Hospital Charge Code	41650124
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
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	$0.55

MAGNESIUM SULFATE 1 GRAM/2 ML INJ

Facility

$0.84

Service Code	HCPCS J3475
Hospital Charge Code	41640124
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42

MAGNESIUM SULFATE 1 GRAM/2 ML INJ

Facility

$0.84

Service Code	HCPCS J3475
Hospital Charge Code	41640124
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
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	$0.55

MAGNESIUM SULFATE 20 GM/500ML IV SOLN [129653]

Facility

$0.01

Service Code	HCPCS J3475
Hospital Charge Code	00409672903
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

MAGNESIUM SULFATE 20 GM/500ML IV SOLN [129653]

Facility

$0.02

Service Code	HCPCS J3475
Hospital Charge Code	63323010615
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
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: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.02
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MAGNESIUM SULFATE 20 GM/500ML IV SOLN [129653]

Facility

$0.01

Service Code	HCPCS J3475
Hospital Charge Code	00409672903
Hospital Revenue Code	278
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
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: EmblemHealth Commercial	$0.01
Rate for Payer: Fidelis Medicare Advantage	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MAGNESIUM SULFATE 20 GM/500ML IV SOLN [129653]

Facility

$0.02

Service Code	HCPCS J3475
Hospital Charge Code	63323010615
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.31

Service Code	HCPCS J3475
Hospital Charge Code	63323010602
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.31

Service Code	HCPCS J3475
Hospital Charge Code	63323010605
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.31

Service Code	HCPCS J3475
Hospital Charge Code	63323010605
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Fidelis Medicare Advantage	$0.32
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.31

Service Code	HCPCS J3475
Hospital Charge Code	63323010602
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Fidelis Medicare Advantage	$0.32
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.23

Service Code	HCPCS J3475
Hospital Charge Code	63323010626
Hospital Revenue Code	278
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Fidelis Medicare Advantage	$0.25
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.11

Service Code	HCPCS J3475
Hospital Charge Code	00264420452
Hospital Revenue Code	278
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.30

Service Code	HCPCS J3475
Hospital Charge Code	00338170840
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.11

Service Code	HCPCS J3475
Hospital Charge Code	00264420452
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Fidelis Medicare Advantage	$0.11
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
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	$0.07

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.30

Service Code	HCPCS J3475
Hospital Charge Code	00338170840
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Fidelis Medicare Advantage	$0.32
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129651]

Facility

$0.23

Service Code	HCPCS J3475
Hospital Charge Code	63323010626
Hospital Revenue Code	278
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12

MAGNESIUM SULFATE 2 GRAMS/50 ML PREMIX

Facility

$0.82

Service Code	HCPCS J3475
Hospital Charge Code	41644691
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
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	$0.53

MAGNESIUM SULFATE 2 GRAMS/50 ML PREMIX

Facility

$0.82

Service Code	HCPCS J3475
Hospital Charge Code	41654691
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
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	$0.53

MAGNESIUM SULFATE 2 GRAMS/50 ML PREMIX

Facility

$0.82

Service Code	HCPCS J3475
Hospital Charge Code	41654691
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41

MAGNESIUM SULFATE 2 GRAMS/50 ML PREMIX

Facility

$0.82

Service Code	HCPCS J3475
Hospital Charge Code	41644691
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41

MAGNESIUM SULFATE 40 GM/1000ML IV SOLN [129654]

Facility

$0.01

Service Code	HCPCS J3475
Hospital Charge Code	00409672909
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

Know your out-of-pocket cost for care.

All Charges