Heights University Hospital

All Charges

Charge

Type

Setting

Price

ERYTHROMYCIN CHEW TAB 250 MG

Facility

$5.65

Hospital Charge Code	60629062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

ERYTHROMYCIN ESTOLATE/125

Facility

$53.00

Hospital Charge Code	60632956
Hospital Revenue Code	250
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$26.50
Rate for Payer: Aetna Commercial	$15.90
Rate for Payer: Aetna Medicare Advantage	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.52
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.89
Rate for Payer: Oxford Commercial	$26.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.95
Rate for Payer: UnitedHealthcare Commercial	$26.50

ERYTHROMYCIN ESTOLATE/125

Facility

$53.00

Hospital Charge Code	60632956
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$7.95
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

ERYTHROMYCIN ESTOLATE/250

Facility

$141.00

Hospital Charge Code	60632957
Hospital Revenue Code	250
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

ERYTHROMYCIN ESTOLATE/250

Facility

$141.00

Hospital Charge Code	60632957
Hospital Revenue Code	250
Min. Negotiated Rate	$18.33
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Aetna Medicare Advantage	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.95
Rate for Payer: Cigna Commercial	$70.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.33
Rate for Payer: Oxford Commercial	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$70.50

ERYTHROMYCIN ETHYLSUCC 400 MG

Facility

$4.00

Hospital Charge Code	60629014
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

ERYTHROMYCIN ETHYLSUCC 400 MG

Facility

$4.00

Hospital Charge Code	60629014
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ERYTHROMYCIN INJ 1GM

Facility

$10.90

Hospital Charge Code	6009203
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

ERYTHROMYCIN INJ 1GM

Facility

$10.90

Hospital Charge Code	6009203
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

ERYTHROMYCIN INJ 500MG

Facility

$34.60

Hospital Charge Code	6009195
Hospital Revenue Code	250
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 INJ 500MG

Facility

$34.60

Hospital Charge Code	6009195
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

ERYTHROMYCIN IVPB 500MG/NS100M

Facility

$54.74

Service Code	HCPCS J1364
Hospital Charge Code	60627279
Hospital Revenue Code	636
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.21

ERYTHROMYCIN IVPB 500MG/NS100M

Facility

$54.74

Service Code	HCPCS J1364
Hospital Charge Code	60627279
Hospital Revenue Code	636
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$91.23
Rate for Payer: Aetna Commercial	$16.42
Rate for Payer: Aetna Medicare Advantage	$16.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.96
Rate for Payer: Cigna Commercial	$91.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.21

ERYTHROMYCIN LACTOB 500MG

Facility

$427.46

Service Code	HCPCS J1364
Hospital Charge Code	60634627
Hospital Revenue Code	636
Min. Negotiated Rate	$64.12
Max. Negotiated Rate	$103.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.45
Rate for Payer: Qualcare PPO/HMO/WC	$64.12

ERYTHROMYCIN LACTOB 500MG

Facility

$427.46

Service Code	HCPCS J1364
Hospital Charge Code	60634627
Hospital Revenue Code	636
Min. Negotiated Rate	$64.12
Max. Negotiated Rate	$128.24
Rate for Payer: Aetna Commercial	$128.24
Rate for Payer: Aetna Medicare Advantage	$128.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.00
Rate for Payer: Cigna Commercial	$91.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.45
Rate for Payer: Qualcare PPO/HMO/WC	$64.12

ERYTHROMYCIN ODD DOSE IVPB

Facility

$28.80

Hospital Charge Code	60627280
Hospital Revenue Code	250
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$8.64
Rate for Payer: Aetna Medicare Advantage	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.34
Rate for Payer: Cigna Commercial	$14.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.74
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.32
Rate for Payer: UnitedHealthcare Commercial	$14.40

ERYTHROMYCIN ODD DOSE IVPB

Facility

$28.80

Hospital Charge Code	60627280
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$4.32

ERYTHROMYCIN OPH OINT 0.5% 1GM

Facility

$16.65

Hospital Charge Code	60628012
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.50

ERYTHROMYCIN OPH OINT 0.5% 1GM

Facility

$16.65

Hospital Charge Code	60628012
Hospital Revenue Code	250
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$8.32
Rate for Payer: Aetna Commercial	$5.00
Rate for Payer: Aetna Medicare Advantage	$5.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.25
Rate for Payer: Cigna Commercial	$8.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.16
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.50
Rate for Payer: UnitedHealthcare Commercial	$8.32

ERYTHROMYCIN OPH OINT .5% 3.5G

Facility

$120.33

Service Code	NDC 574402435
Hospital Charge Code	60628011
Hospital Revenue Code	250
Min. Negotiated Rate	$18.05
Max. Negotiated Rate	$18.05
Rate for Payer: Qualcare PPO/HMO/WC	$18.05

ERYTHROMYCIN OPH OINT .5% 3.5G

Facility

$120.33

Service Code	NDC 574402435
Hospital Charge Code	60628011
Hospital Revenue Code	250
Min. Negotiated Rate	$15.64
Max. Negotiated Rate	$60.16
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$36.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.68
Rate for Payer: Cigna Commercial	$60.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.64
Rate for Payer: Oxford Commercial	$60.16
Rate for Payer: Qualcare PPO/HMO/WC	$18.05
Rate for Payer: UnitedHealthcare Commercial	$60.16

ERYTHROMYCIN SSP100MG/2.5ML50M

Facility

$2.45

Hospital Charge Code	60627276
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

ERYTHROMYCIN SSP100MG/2.5ML50M

Facility

$2.45

Hospital Charge Code	60627276
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

ERYTHROMYCIN SSP 200MG/5ML

Facility

$24.12

Service Code	NDC 24338013213
Hospital Charge Code	60629131
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

ERYTHROMYCIN SSP 200MG/5ML

Facility

$24.12

Service Code	NDC 24338013213
Hospital Charge Code	60629131
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$7.24
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$12.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$12.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$12.06

Know your out-of-pocket cost for care.

All Charges