Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LEVOCARNITINE 1 GM/10ML PO SOLN

Facility

OP

$0.42

Service Code	NDC 5448214508
Hospital Charge Code	5448214508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
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	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

LEVOCARNITINE 1 GM/10ML PO SOLN

Facility

IP

$0.42

Service Code	NDC 5448214508
Hospital Charge Code	5448214508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

LEVOCARNITINE 1 GM/10ML PO SOLN

Facility

OP

$0.39

Service Code	NDC 6498050312
Hospital Charge Code	6498050312
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

LEVOCARNITINE 1 GM/10ML PO SOLN

Facility

IP

$0.39

Service Code	NDC 7095414010
Hospital Charge Code	7095414010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

LEVOCARNITINE 1 GM/10ML PO SOLN

Facility

IP

$0.39

Service Code	NDC 6498050312
Hospital Charge Code	6498050312
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

LEVOCARNITINE 1 GM/10ML PO SOLN

Facility

OP

$0.39

Service Code	NDC 7095414010
Hospital Charge Code	7095414010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

LEVOCARNITINE 200 MG/ML IV SOLN

Facility

OP

$9.11

Service Code	HCPCS J1955
Hospital Charge Code	5448214701
Hospital Revenue Code	258
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$23.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.06
Rate for Payer: Aetna Government	$21.06
Rate for Payer: Brighton Health Commercial	$6.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.19
Rate for Payer: EmblemHealth Commercial	$4.55
Rate for Payer: Group Health Inc Commercial	$4.55
Rate for Payer: Group Health Inc Medicare	$3.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.55
Rate for Payer: Hamaspik Choice Inc Medicare	$4.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.92

LEVOCARNITINE 200 MG/ML IV SOLN

Facility

IP

$9.11

Service Code	HCPCS J1955
Hospital Charge Code	5448214701
Hospital Revenue Code	258
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.55

LEVOFLOXACIN 250 MG PO TABS

Facility

OP

$14.73

Service Code	NDC 0904635161
Hospital Charge Code	0904635161
Hospital Revenue Code	250
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$11.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.36
Rate for Payer: Aetna Government	$7.36
Rate for Payer: Brighton Health Commercial	$11.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.01
Rate for Payer: EmblemHealth Commercial	$7.36
Rate for Payer: Group Health Inc Commercial	$7.36
Rate for Payer: Group Health Inc Medicare	$5.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.36
Rate for Payer: Hamaspik Choice Inc Medicare	$7.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.57

LEVOFLOXACIN 250 MG PO TABS

Facility

IP

$14.73

Service Code	NDC 0904635161
Hospital Charge Code	0904635161
Hospital Revenue Code	250
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$7.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.36

LEVOFLOXACIN 500 MG PO TABS

Facility

IP

$16.82

Service Code	NDC 0904635261
Hospital Charge Code	0904635261
Hospital Revenue Code	250
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$8.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.41

LEVOFLOXACIN 500 MG PO TABS

Facility

OP

$20.09

Service Code	NDC 5511128050
Hospital Charge Code	5511128050
Hospital Revenue Code	250
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$16.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.04
Rate for Payer: Aetna Government	$10.04
Rate for Payer: Brighton Health Commercial	$15.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.66
Rate for Payer: EmblemHealth Commercial	$10.04
Rate for Payer: Group Health Inc Commercial	$10.04
Rate for Payer: Group Health Inc Medicare	$7.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.04
Rate for Payer: Hamaspik Choice Inc Medicare	$10.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.06

LEVOFLOXACIN 500 MG PO TABS

Facility

OP

$16.82

Service Code	NDC 0904635261
Hospital Charge Code	0904635261
Hospital Revenue Code	250
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$13.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.41
Rate for Payer: Aetna Government	$8.41
Rate for Payer: Brighton Health Commercial	$12.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.44
Rate for Payer: EmblemHealth Commercial	$8.41
Rate for Payer: Group Health Inc Commercial	$8.41
Rate for Payer: Group Health Inc Medicare	$5.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.41
Rate for Payer: Hamaspik Choice Inc Medicare	$8.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.93

LEVOFLOXACIN 500 MG PO TABS

Facility

IP

$20.09

Service Code	NDC 5511128050
Hospital Charge Code	5511128050
Hospital Revenue Code	250
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$10.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.04

LEVOFLOXACIN 750 MG PO TABS

Facility

OP

$24.61

Service Code	NDC 0904635361
Hospital Charge Code	0904635361
Hospital Revenue Code	250
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$19.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.31
Rate for Payer: Aetna Government	$12.31
Rate for Payer: Brighton Health Commercial	$18.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.74
Rate for Payer: EmblemHealth Commercial	$12.31
Rate for Payer: Group Health Inc Commercial	$12.31
Rate for Payer: Group Health Inc Medicare	$8.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.31
Rate for Payer: Hamaspik Choice Inc Medicare	$12.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.00

LEVOFLOXACIN 750 MG PO TABS

Facility

IP

$24.61

Service Code	NDC 0904635361
Hospital Charge Code	0904635361
Hospital Revenue Code	250
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$12.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.31

LEVOFLOXACIN 750 MG PO TABS

Facility

OP

$36.08

Service Code	NDC 6586253820
Hospital Charge Code	6586253820
Hospital Revenue Code	250
Min. Negotiated Rate	$12.63
Max. Negotiated Rate	$28.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.04
Rate for Payer: Aetna Government	$18.04
Rate for Payer: Brighton Health Commercial	$27.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.53
Rate for Payer: EmblemHealth Commercial	$18.04
Rate for Payer: Group Health Inc Commercial	$18.04
Rate for Payer: Group Health Inc Medicare	$12.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.04
Rate for Payer: Hamaspik Choice Inc Medicare	$18.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.45

LEVOFLOXACIN 750 MG PO TABS

Facility

IP

$36.08

Service Code	NDC 6586253820
Hospital Charge Code	6586253820
Hospital Revenue Code	250
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$18.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.04

LEVOFLOXACIN 750 MG PO TABS

Facility

IP

$36.12

Service Code	NDC 3172272320
Hospital Charge Code	3172272320
Hospital Revenue Code	250
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$18.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.06

LEVOFLOXACIN 750 MG PO TABS

Facility

OP

$36.12

Service Code	NDC 3172272320
Hospital Charge Code	3172272320
Hospital Revenue Code	250
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$28.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.06
Rate for Payer: Aetna Government	$18.06
Rate for Payer: Brighton Health Commercial	$27.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.56
Rate for Payer: EmblemHealth Commercial	$18.06
Rate for Payer: Group Health Inc Commercial	$18.06
Rate for Payer: Group Health Inc Medicare	$12.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.06
Rate for Payer: Hamaspik Choice Inc Medicare	$18.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.48

LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN

Facility

OP

$0.14

Service Code	HCPCS J1956
Hospital Charge Code	0143972201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.91
Rate for Payer: Aetna Government	$0.91
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	$0.07
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	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN

Facility

IP

$0.14

Service Code	HCPCS J1956
Hospital Charge Code	0143972224
Hospital Revenue Code	258
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN

Facility

OP

$0.14

Service Code	HCPCS J1956
Hospital Charge Code	0143972224
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.91
Rate for Payer: Aetna Government	$0.91
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	$0.07
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	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN

Facility

IP

$0.14

Service Code	HCPCS J1956
Hospital Charge Code	0143972201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN

Facility

IP

$0.15

Service Code	HCPCS J1956
Hospital Charge Code	4456743624
Hospital Revenue Code	258
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

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