St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEVETIRACETAM 750 MG PO TABS

Facility

$0.34

Service Code	NDC 6373978710
Hospital Charge Code	6373978710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

LEVETIRACETAM 750 MG PO TABS

Facility

$0.34

Service Code	NDC 6373978710
Hospital Charge Code	6373978710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
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	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
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	$0.22

LEVETIRACETAM 750 MG PO TABS

Facility

$4.76

Service Code	NDC 0378561778
Hospital Charge Code	0378561778
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$3.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.38
Rate for Payer: Aetna Government	$2.38
Rate for Payer: Brighton Health Commercial	$3.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.24
Rate for Payer: EmblemHealth Commercial	$2.38
Rate for Payer: Group Health Inc Commercial	$2.38
Rate for Payer: Group Health Inc Medicare	$1.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.09

LEVETIRACETAM 750 MG PO TABS

Facility

$4.76

Service Code	NDC 0378561778
Hospital Charge Code	0378561778
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$2.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.38

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.09

Service Code	HCPCS J1953
Hospital Charge Code	0264100990
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.26

Service Code	HCPCS J1953
Hospital Charge Code	6745726510
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.26

Service Code	HCPCS J1953
Hospital Charge Code	6745726510
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.13

Service Code	HCPCS J1953
Hospital Charge Code	4456750210
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.26

Service Code	HCPCS J1953
Hospital Charge Code	1478922010
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.26

Service Code	HCPCS J1953
Hospital Charge Code	1478922010
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.26

Service Code	HCPCS J1953
Hospital Charge Code	1478922008
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.26

Service Code	HCPCS J1953
Hospital Charge Code	1478922008
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.54

Service Code	HCPCS J1953
Hospital Charge Code	5515024747
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.54

Service Code	HCPCS J1953
Hospital Charge Code	5515024747
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.13

Service Code	HCPCS J1953
Hospital Charge Code	4456750201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.09

Service Code	HCPCS J1953
Hospital Charge Code	0264100990
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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: EmblemHealth Commercial	$0.05
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: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$5.89

Service Code	HCPCS J1953
Hospital Charge Code	3600035601
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$4.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$4.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.01
Rate for Payer: EmblemHealth Commercial	$2.94
Rate for Payer: Group Health Inc Commercial	$2.94
Rate for Payer: Group Health Inc Medicare	$2.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.94
Rate for Payer: Hamaspik Choice Inc Medicare	$2.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.83

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.13

Service Code	HCPCS J1953
Hospital Charge Code	4456750210
Hospital Revenue Code	258
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$5.89

Service Code	HCPCS J1953
Hospital Charge Code	3600035601
Hospital Revenue Code	258
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$2.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.94

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.13

Service Code	HCPCS J1953
Hospital Charge Code	4456750201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.67

Service Code	HCPCS J1953
Hospital Charge Code	7086060382
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
Rate for Payer: EmblemHealth Commercial	$0.34
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN

Facility

$0.67

Service Code	HCPCS J1953
Hospital Charge Code	7086060382
Hospital Revenue Code	258
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.18

Service Code	HCPCS J1953
Hospital Charge Code	4456750301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.18

Service Code	HCPCS J1953
Hospital Charge Code	4456750301
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.18

Service Code	HCPCS J1953
Hospital Charge Code	4456750310
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

Know your out-of-pocket cost for care.

All Charges