St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.72

Service Code	HCPCS J1953
Hospital Charge Code	5515024847
Hospital Revenue Code	258
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.34

Service Code	HCPCS J1953
Hospital Charge Code	1478933015
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.34

Service Code	HCPCS J1953
Hospital Charge Code	1478933015
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.34

Service Code	HCPCS J1953
Hospital Charge Code	1478933008
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

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	$0.04
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

$7.97

Service Code	HCPCS J1953
Hospital Charge Code	3600035401
Hospital Revenue Code	258
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.15

Service Code	HCPCS J1953
Hospital Charge Code	0264150990
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$7.97

Service Code	HCPCS J1953
Hospital Charge Code	3600035401
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$6.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$5.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.42
Rate for Payer: EmblemHealth Commercial	$3.98
Rate for Payer: Group Health Inc Commercial	$3.98
Rate for Payer: Group Health Inc Medicare	$2.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98
Rate for Payer: Hamaspik Choice Inc Medicare	$3.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.18

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.15

Service Code	HCPCS J1953
Hospital Charge Code	0264150990
Hospital Revenue Code	258
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.34

Service Code	HCPCS J1953
Hospital Charge Code	1478933008
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN

Facility

$0.72

Service Code	HCPCS J1953
Hospital Charge Code	5515024847
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.17

Service Code	HCPCS J1953
Hospital Charge Code	1478911008
Hospital Revenue Code	258
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.41

Service Code	HCPCS J1953
Hospital Charge Code	7086060241
Hospital Revenue Code	258
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.07

Service Code	HCPCS J1953
Hospital Charge Code	3600035240
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.17

Service Code	HCPCS J1953
Hospital Charge Code	1478911008
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.41

Service Code	HCPCS J1953
Hospital Charge Code	7086060241
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.07

Service Code	HCPCS J1953
Hospital Charge Code	3600035240
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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: EmblemHealth Commercial	$0.04
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: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.07

Service Code	HCPCS J1953
Hospital Charge Code	3600035201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
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: EmblemHealth Commercial	$0.04
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: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.33

Service Code	HCPCS J1953
Hospital Charge Code	5515024647
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.17

Service Code	HCPCS J1953
Hospital Charge Code	6745725500
Hospital Revenue Code	258
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.33

Service Code	HCPCS J1953
Hospital Charge Code	5515024647
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.25
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: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.17

Service Code	HCPCS J1953
Hospital Charge Code	6745725500
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN

Facility

$0.07

Service Code	HCPCS J1953
Hospital Charge Code	3600035201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

LEVOBUNOLOL HCL 0.5 % OP SOLN

Facility

$4.84

Service Code	NDC 2420850505
Hospital Charge Code	2420850505
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$3.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$3.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.29
Rate for Payer: EmblemHealth Commercial	$2.42
Rate for Payer: Group Health Inc Commercial	$2.42
Rate for Payer: Group Health Inc Medicare	$1.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.42
Rate for Payer: Hamaspik Choice Inc Medicare	$2.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.14

LEVOBUNOLOL HCL 0.5 % OP SOLN

Facility

$4.84

Service Code	NDC 2420850505
Hospital Charge Code	2420850505
Hospital Revenue Code	250
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.42

Know your out-of-pocket cost for care.

All Charges