Heights University Hospital

All Charges

Charge

Type

Setting

Price

ERYTHROCIN STEARATE/250MG

Facility

$4.00

Hospital Charge Code	60632952
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

ERYTHROCIN STEARATE/250MG

Facility

$4.00

Hospital Charge Code	60632953
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

ERYTHROCYTE PROTOPORPHYRIN

Facility

$153.65

Service Code	HCPCS 84202
Hospital Charge Code	3008430
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

ERYTHROCYTE PROTOPORPHYRIN

Facility

$153.65

Service Code	HCPCS 84202
Hospital Charge Code	3008430
Hospital Revenue Code	301
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.49
Rate for Payer: Aetna Medicare Advantage	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.58
Rate for Payer: Cigna Commercial	$14.35
Rate for Payer: Cigna Medicare Advantage	$7.17
Rate for Payer: Clover Medicare Advantage	$13.63
Rate for Payer: EmblemHealth Commercial	$43.05
Rate for Payer: Humana Medicare Advantage	$14.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.21
Rate for Payer: Wellcare Medicare Advantage	$14.35

ERYTHRO LACTOB INJ 1GM

Facility

$158.45

Hospital Charge Code	6002257
Hospital Revenue Code	250
Min. Negotiated Rate	$20.60
Max. Negotiated Rate	$79.22
Rate for Payer: Aetna Commercial	$47.53
Rate for Payer: Aetna Medicare Advantage	$47.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.40
Rate for Payer: Cigna Commercial	$79.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.60
Rate for Payer: Oxford Commercial	$79.22
Rate for Payer: Qualcare PPO/HMO/WC	$23.77
Rate for Payer: UnitedHealthcare Commercial	$79.22

ERYTHRO LACTOB INJ 1GM

Facility

$158.45

Hospital Charge Code	6002257
Hospital Revenue Code	250
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$23.77
Rate for Payer: Qualcare PPO/HMO/WC	$23.77

ERYTHROM ETHYL LIQ 200 MG 100M

Facility

$34.60

Hospital Charge Code	6002240
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

ERYTHROM ETHYL LIQ 200 MG 100M

Facility

$34.60

Hospital Charge Code	6002240
Hospital Revenue Code	251
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

ERYTHROMYCIN 2% TOP SOLN

Facility

$39.30

Hospital Charge Code	60629291
Hospital Revenue Code	259
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

ERYTHROMYCIN 2% TOP SOLN

Facility

$39.30

Hospital Charge Code	60629291
Hospital Revenue Code	259
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$19.65
Rate for Payer: Aetna Commercial	$11.79
Rate for Payer: Aetna Medicare Advantage	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.02
Rate for Payer: Cigna Commercial	$19.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.11
Rate for Payer: Oxford Commercial	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$19.65

ERYTHROMYCIN 333 MG PC TAB

Facility

$11.25

Hospital Charge Code	60627274
Hospital Revenue Code	251
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

ERYTHROMYCIN 333 MG PC TAB

Facility

$11.25

Hospital Charge Code	60627274
Hospital Revenue Code	251
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

ERYTHROMYCIN 400MG/5ML SUSP

Facility

$4.00

Hospital Charge Code	60627278
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

ERYTHROMYCIN 400MG/5ML SUSP

Facility

$4.00

Hospital Charge Code	60627278
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ERYTHROMYCIN ADDV/1G

Facility

$83.00

Hospital Charge Code	60634459
Hospital Revenue Code	250
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

ERYTHROMYCIN ADDV/1G

Facility

$83.00

Hospital Charge Code	60634459
Hospital Revenue Code	250
Min. Negotiated Rate	$10.79
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$24.90
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: Oxford Commercial	$41.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$41.50

ERYTHROMYCIN ADDV/500MG

Facility

$43.00

Hospital Charge Code	60634458
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

ERYTHROMYCIN ADDV/500MG

Facility

$43.00

Hospital Charge Code	60634458
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

ERYTHROMYCIN BASE/250MG/1

Facility

$7.00

Hospital Charge Code	60632954
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

ERYTHROMYCIN BASE/250MG/1

Facility

$7.00

Hospital Charge Code	60632954
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

ERYTHROMYCIN BASE 250 MG TAB

Facility

$4.15

Service Code	NDC 66267009020
Hospital Charge Code	6022446
Hospital Revenue Code	251
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

ERYTHROMYCIN BASE 250 MG TAB

Facility

$4.15

Service Code	NDC 66267009020
Hospital Charge Code	6022446
Hospital Revenue Code	251
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare Advantage	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.06
Rate for Payer: Cigna Commercial	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.54
Rate for Payer: Oxford Commercial	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$2.08

ERYTHROMYCIN BASE 2%/60ML

Facility

$18.00

Hospital Charge Code	60632955
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

ERYTHROMYCIN BASE 2%/60ML

Facility

$18.00

Hospital Charge Code	60632955
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

ERYTHROMYCIN CHEW TAB 250 MG

Facility

$5.65

Hospital Charge Code	60629062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

Know your out-of-pocket cost for care.

All Charges