Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN

Facility

OP

$21.29

Service Code	NDC 6332388510
Hospital Charge Code	6332388510
Hospital Revenue Code	258
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$17.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.64
Rate for Payer: Aetna Government	$10.64
Rate for Payer: Brighton Health Commercial	$15.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.47
Rate for Payer: EmblemHealth Commercial	$10.64
Rate for Payer: Group Health Inc Commercial	$10.64
Rate for Payer: Group Health Inc Medicare	$7.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.64
Rate for Payer: Hamaspik Choice Inc Medicare	$10.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.84

LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN

Facility

IP

$17.98

Service Code	NDC 6332388512
Hospital Charge Code	6332388512
Hospital Revenue Code	258
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$8.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.99

LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN

Facility

OP

$17.98

Service Code	NDC 6332388512
Hospital Charge Code	6332388512
Hospital Revenue Code	258
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$14.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.99
Rate for Payer: Aetna Government	$8.99
Rate for Payer: Brighton Health Commercial	$13.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.23
Rate for Payer: EmblemHealth Commercial	$8.99
Rate for Payer: Group Health Inc Commercial	$8.99
Rate for Payer: Group Health Inc Medicare	$6.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.99
Rate for Payer: Hamaspik Choice Inc Medicare	$8.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.69

LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN

Facility

IP

$21.29

Service Code	NDC 6332388510
Hospital Charge Code	6332388510
Hospital Revenue Code	258
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$10.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.64

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

IP

$113.40

Service Code	NDC 2502146810
Hospital Charge Code	2502146810
Hospital Revenue Code	258
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$56.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

IP

$113.40

Service Code	NDC 7086045110
Hospital Charge Code	7086045110
Hospital Revenue Code	258
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$56.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

IP

$126.70

Service Code	NDC 6332364907
Hospital Charge Code	6332364907
Hospital Revenue Code	258
Min. Negotiated Rate	$63.35
Max. Negotiated Rate	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.35

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

OP

$113.40

Service Code	NDC 2502146810
Hospital Charge Code	2502146810
Hospital Revenue Code	258
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$90.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.70
Rate for Payer: Aetna Government	$56.70
Rate for Payer: Brighton Health Commercial	$85.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.11
Rate for Payer: EmblemHealth Commercial	$56.70
Rate for Payer: Group Health Inc Commercial	$56.70
Rate for Payer: Group Health Inc Medicare	$39.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$56.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.71

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

OP

$126.70

Service Code	NDC 4202320101
Hospital Charge Code	4202320101
Hospital Revenue Code	258
Min. Negotiated Rate	$44.34
Max. Negotiated Rate	$101.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.35
Rate for Payer: Aetna Government	$63.35
Rate for Payer: Brighton Health Commercial	$95.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$101.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.16
Rate for Payer: EmblemHealth Commercial	$63.35
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$44.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.35
Rate for Payer: Hamaspik Choice Inc Medicare	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.36

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

OP

$113.40

Service Code	NDC 7086045110
Hospital Charge Code	7086045110
Hospital Revenue Code	258
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$90.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.70
Rate for Payer: Aetna Government	$56.70
Rate for Payer: Brighton Health Commercial	$85.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.11
Rate for Payer: EmblemHealth Commercial	$56.70
Rate for Payer: Group Health Inc Commercial	$56.70
Rate for Payer: Group Health Inc Medicare	$39.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$56.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.71

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

IP

$126.70

Service Code	NDC 4202320101
Hospital Charge Code	4202320101
Hospital Revenue Code	258
Min. Negotiated Rate	$63.35
Max. Negotiated Rate	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.35

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

IP

$110.17

Service Code	NDC 6332364994
Hospital Charge Code	6332364994
Hospital Revenue Code	258
Min. Negotiated Rate	$55.09
Max. Negotiated Rate	$55.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.09

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

OP

$126.70

Service Code	NDC 6332364907
Hospital Charge Code	6332364907
Hospital Revenue Code	258
Min. Negotiated Rate	$44.34
Max. Negotiated Rate	$101.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.35
Rate for Payer: Aetna Government	$63.35
Rate for Payer: Brighton Health Commercial	$95.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$101.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.16
Rate for Payer: EmblemHealth Commercial	$63.35
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$44.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.35
Rate for Payer: Hamaspik Choice Inc Medicare	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.36

LEVOTHYROXINE SODIUM 100 MCG IV SOLR

Facility

OP

$110.17

Service Code	NDC 6332364994
Hospital Charge Code	6332364994
Hospital Revenue Code	258
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$88.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.09
Rate for Payer: Aetna Government	$55.09
Rate for Payer: Brighton Health Commercial	$82.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.92
Rate for Payer: EmblemHealth Commercial	$55.09
Rate for Payer: Group Health Inc Commercial	$55.09
Rate for Payer: Group Health Inc Medicare	$38.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.09
Rate for Payer: Hamaspik Choice Inc Medicare	$55.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.61

LEVOTHYROXINE SODIUM 100 MCG/ML IV SOLN

Facility

OP

$89.92

Service Code	NDC 2420100201
Hospital Charge Code	2420100201
Hospital Revenue Code	258
Min. Negotiated Rate	$31.47
Max. Negotiated Rate	$71.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.96
Rate for Payer: Aetna Government	$44.96
Rate for Payer: Brighton Health Commercial	$67.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.15
Rate for Payer: EmblemHealth Commercial	$44.96
Rate for Payer: Group Health Inc Commercial	$44.96
Rate for Payer: Group Health Inc Medicare	$31.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.96
Rate for Payer: Hamaspik Choice Inc Medicare	$44.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.45

LEVOTHYROXINE SODIUM 100 MCG/ML IV SOLN

Facility

IP

$89.92

Service Code	NDC 2420100201
Hospital Charge Code	2420100201
Hospital Revenue Code	258
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$44.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.96

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

OP

$0.56

Service Code	NDC 0378180977
Hospital Charge Code	0378180977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

IP

$0.70

Service Code	NDC 0904695361
Hospital Charge Code	0904695361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

OP

$0.20

Service Code	NDC 7230510030
Hospital Charge Code	7230510030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

IP

$0.20

Service Code	NDC 7230510030
Hospital Charge Code	7230510030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

IP

$0.56

Service Code	NDC 0378180977
Hospital Charge Code	0378180977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

IP

$0.61

Service Code	NDC 5107944220
Hospital Charge Code	5107944220
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

OP

$0.70

Service Code	NDC 0904695361
Hospital Charge Code	0904695361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: EmblemHealth Commercial	$0.35
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

OP

$0.72

Service Code	NDC 6068749711
Hospital Charge Code	6068749711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

LEVOTHYROXINE SODIUM 100 MCG PO TABS

Facility

IP

$0.72

Service Code	NDC 6068749711
Hospital Charge Code	6068749711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

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