St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN

Facility

$0.15

Service Code	HCPCS J1956
Hospital Charge Code	4456743624
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	$0.08
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	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN

Facility

$0.09

Service Code	HCPCS J1956
Hospital Charge Code	2502113283
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN

Facility

$0.05

Service Code	HCPCS J1956
Hospital Charge Code	0143972024
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN

Facility

$0.05

Service Code	HCPCS J1956
Hospital Charge Code	3600004824
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.91
Rate for Payer: Aetna Government	$0.91
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN

Facility

$0.09

Service Code	HCPCS J1956
Hospital Charge Code	2502113283
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.91
Rate for Payer: Aetna Government	$0.91
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	$0.04
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	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN

Facility

$0.05

Service Code	HCPCS J1956
Hospital Charge Code	0143972024
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.91
Rate for Payer: Aetna Government	$0.91
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN

Facility

$0.05

Service Code	HCPCS J1956
Hospital Charge Code	3600004824
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

LEVONORGESTREL 1.5 MG PO TABS

Facility

$6.25

Service Code	NDC 0536143363
Hospital Charge Code	0536143363
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12

LEVONORGESTREL 1.5 MG PO TABS

Facility

$39.00

Service Code	NDC 6953616288
Hospital Charge Code	6953616288
Hospital Revenue Code	250
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.50

LEVONORGESTREL 1.5 MG PO TABS

Facility

$36.55

Service Code	NDC 7070016406
Hospital Charge Code	7070016406
Hospital Revenue Code	250
Min. Negotiated Rate	$12.79
Max. Negotiated Rate	$29.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.27
Rate for Payer: Aetna Government	$18.27
Rate for Payer: Brighton Health Commercial	$27.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.85
Rate for Payer: EmblemHealth Commercial	$18.27
Rate for Payer: Group Health Inc Commercial	$18.27
Rate for Payer: Group Health Inc Medicare	$12.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.27
Rate for Payer: Hamaspik Choice Inc Medicare	$18.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.76

LEVONORGESTREL 1.5 MG PO TABS

Facility

$25.00

Service Code	NDC 6275672060
Hospital Charge Code	6275672060
Hospital Revenue Code	250
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$20.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$18.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.00
Rate for Payer: EmblemHealth Commercial	$12.50
Rate for Payer: Group Health Inc Commercial	$12.50
Rate for Payer: Group Health Inc Medicare	$8.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.25

LEVONORGESTREL 1.5 MG PO TABS

Facility

$36.55

Service Code	NDC 7070016406
Hospital Charge Code	7070016406
Hospital Revenue Code	250
Min. Negotiated Rate	$18.27
Max. Negotiated Rate	$18.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.27

LEVONORGESTREL 1.5 MG PO TABS

Facility

$9.05

Service Code	NDC 0536114263
Hospital Charge Code	0536114263
Hospital Revenue Code	250
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.53

LEVONORGESTREL 1.5 MG PO TABS

Facility

$25.00

Service Code	NDC 6275672060
Hospital Charge Code	6275672060
Hospital Revenue Code	250
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50

LEVONORGESTREL 1.5 MG PO TABS

Facility

$36.56

Service Code	NDC 6818085211
Hospital Charge Code	6818085211
Hospital Revenue Code	250
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$29.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.28
Rate for Payer: Aetna Government	$18.28
Rate for Payer: Brighton Health Commercial	$27.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.86
Rate for Payer: EmblemHealth Commercial	$18.28
Rate for Payer: Group Health Inc Commercial	$18.28
Rate for Payer: Group Health Inc Medicare	$12.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.28
Rate for Payer: Hamaspik Choice Inc Medicare	$18.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.76

LEVONORGESTREL 1.5 MG PO TABS

Facility

$39.00

Service Code	NDC 6953616288
Hospital Charge Code	6953616288
Hospital Revenue Code	250
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$31.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.50
Rate for Payer: Aetna Government	$19.50
Rate for Payer: Brighton Health Commercial	$29.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.52
Rate for Payer: EmblemHealth Commercial	$19.50
Rate for Payer: Group Health Inc Commercial	$19.50
Rate for Payer: Group Health Inc Medicare	$13.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.50
Rate for Payer: Hamaspik Choice Inc Medicare	$19.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.35

LEVONORGESTREL 1.5 MG PO TABS

Facility

$6.25

Service Code	NDC 0536143363
Hospital Charge Code	0536143363
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$5.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.12
Rate for Payer: Aetna Government	$3.12
Rate for Payer: Brighton Health Commercial	$4.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.25
Rate for Payer: EmblemHealth Commercial	$3.12
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

LEVONORGESTREL 1.5 MG PO TABS

Facility

$9.05

Service Code	NDC 0536114263
Hospital Charge Code	0536114263
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$7.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.53
Rate for Payer: Aetna Government	$4.53
Rate for Payer: Brighton Health Commercial	$6.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.15
Rate for Payer: EmblemHealth Commercial	$4.53
Rate for Payer: Group Health Inc Commercial	$4.53
Rate for Payer: Group Health Inc Medicare	$3.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.53
Rate for Payer: Hamaspik Choice Inc Medicare	$4.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.88

LEVONORGESTREL 1.5 MG PO TABS

Facility

$36.56

Service Code	NDC 6818085211
Hospital Charge Code	6818085211
Hospital Revenue Code	250
Min. Negotiated Rate	$18.28
Max. Negotiated Rate	$18.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.28

LEVONORGESTREL 20.1 MCG/DAY IU IUD

Facility

$1.00

Service Code	HCPCS J7297
Hospital Charge Code	0023585801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$845.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$845.10
Rate for Payer: Aetna Government	$845.10
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: EmblemHealth Commercial	$0.50
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

LEVONORGESTREL 20.1 MCG/DAY IU IUD

Facility

$1.00

Service Code	HCPCS J7297
Hospital Charge Code	0023585801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

LEVONORGESTREL 20 MCG/DAY IU IUD

Facility

$1.00

Service Code	HCPCS J7298
Hospital Charge Code	5041942301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

LEVONORGESTREL 20 MCG/DAY IU IUD

Facility

$1.00

Service Code	HCPCS J7298
Hospital Charge Code	5041942301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$999.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$999.28
Rate for Payer: Aetna Government	$999.28
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: EmblemHealth Commercial	$0.50
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

LEVONORGESTREL-ETHINYL ESTRAD 0.15-30 MG-MCG PO TABS

Facility

$1.11

Service Code	NDC 6923815546
Hospital Charge Code	6923815546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$0.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.75
Rate for Payer: EmblemHealth Commercial	$0.55
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.72

LEVONORGESTREL-ETHINYL ESTRAD 0.15-30 MG-MCG PO TABS

Facility

$1.11

Service Code	NDC 6923815546
Hospital Charge Code	6923815546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55

Know your out-of-pocket cost for care.

All Charges