Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

OP

$12.70

Service Code	NDC 69238-1484-3
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$9.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.62
Rate for Payer: Aetna of CA Government/Medicare	$7.62
Rate for Payer: Cash Price	$5.72
Rate for Payer: Health Smart Auto/Commercial	$7.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.62
Rate for Payer: LLUH Dept of Risk Management WC	$6.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.52

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

IP

$6.75

Service Code	NDC 75834-242-30
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.40
Rate for Payer: Cash Price	$3.04
Rate for Payer: Cigna of CA HMO/PPO	$5.40
Rate for Payer: Health Smart Auto/Commercial	$4.05
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.06

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

OP

$6.75

Service Code	NDC 75834-242-30
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.05
Rate for Payer: Aetna of CA Government/Medicare	$4.05
Rate for Payer: Cash Price	$3.04
Rate for Payer: Health Smart Auto/Commercial	$4.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.05
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.06

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

IP

$13.93

Service Code	NDC 24338-102-03
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$11.14
Rate for Payer: Cash Price	$6.27
Rate for Payer: Cigna of CA HMO/PPO	$11.14
Rate for Payer: Health Smart Auto/Commercial	$8.36
Rate for Payer: LLUH Dept of Risk Management WC	$7.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.45

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

IP

$7.94

Service Code	NDC 0093-5571-56
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$6.35
Rate for Payer: Cash Price	$3.57
Rate for Payer: Cigna of CA HMO/PPO	$6.35
Rate for Payer: Health Smart Auto/Commercial	$4.76
Rate for Payer: LLUH Dept of Risk Management WC	$4.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.96

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

IP

$12.70

Service Code	NDC 69238-1484-3
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$10.16
Rate for Payer: Cash Price	$5.72
Rate for Payer: Cigna of CA HMO/PPO	$10.16
Rate for Payer: Health Smart Auto/Commercial	$7.62
Rate for Payer: LLUH Dept of Risk Management WC	$6.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.52

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

IP

$11.28

Service Code	NDC 52536-103-03
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$9.02
Rate for Payer: Cash Price	$5.08
Rate for Payer: Cigna of CA HMO/PPO	$9.02
Rate for Payer: Health Smart Auto/Commercial	$6.77
Rate for Payer: LLUH Dept of Risk Management WC	$6.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.46

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

IP

$13.93

Service Code	NDC 24338-102-13
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$11.14
Rate for Payer: Cash Price	$6.27
Rate for Payer: Cigna of CA HMO/PPO	$11.14
Rate for Payer: Health Smart Auto/Commercial	$8.36
Rate for Payer: LLUH Dept of Risk Management WC	$7.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.45

ERYTHROMYCIN 250 MG TABLET [2889]

Facility

OP

$13.93

Service Code	NDC 24338-102-03
Hospital Charge Code	1710431
Hospital Revenue Code	259
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$10.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.36
Rate for Payer: Aetna of CA Government/Medicare	$8.36
Rate for Payer: Cash Price	$6.27
Rate for Payer: Health Smart Auto/Commercial	$8.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.36
Rate for Payer: LLUH Dept of Risk Management WC	$7.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.45

ERYTHROMYCIN 500 MG TABLET [2890]

Facility

IP

$20.99

Service Code	NDC 24338-104-13
Hospital Charge Code	1712322
Hospital Revenue Code	259
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$16.79
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cigna of CA HMO/PPO	$16.79
Rate for Payer: Health Smart Auto/Commercial	$12.59
Rate for Payer: LLUH Dept of Risk Management WC	$11.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.74

ERYTHROMYCIN 500 MG TABLET [2890]

Facility

OP

$20.99

Service Code	NDC 24338-104-13
Hospital Charge Code	1712322
Hospital Revenue Code	259
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$15.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.59
Rate for Payer: Aetna of CA Government/Medicare	$12.59
Rate for Payer: Cash Price	$9.45
Rate for Payer: Health Smart Auto/Commercial	$12.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.59
Rate for Payer: LLUH Dept of Risk Management WC	$11.54
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.74

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]

Facility

IP

$5.21

Service Code	NDC 24208-910-55
Hospital Charge Code	1740208
Hospital Revenue Code	259
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$4.17
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cigna of CA HMO/PPO	$4.17
Rate for Payer: Health Smart Auto/Commercial	$3.13
Rate for Payer: LLUH Dept of Risk Management WC	$2.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.91

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]

Facility

IP

$5.12

Service Code	NDC 17478-070-35
Hospital Charge Code	1740208
Hospital Revenue Code	259
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$4.10
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cigna of CA HMO/PPO	$4.10
Rate for Payer: Health Smart Auto/Commercial	$3.07
Rate for Payer: LLUH Dept of Risk Management WC	$2.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.84

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]

Facility

OP

$5.12

Service Code	NDC 17478-070-35
Hospital Charge Code	1740208
Hospital Revenue Code	259
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$3.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.07
Rate for Payer: Aetna of CA Government/Medicare	$3.07
Rate for Payer: Cash Price	$2.30
Rate for Payer: Health Smart Auto/Commercial	$3.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.07
Rate for Payer: LLUH Dept of Risk Management WC	$2.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.84

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]

Facility

OP

$5.21

Service Code	NDC 24208-910-55
Hospital Charge Code	1740208
Hospital Revenue Code	259
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$3.91
Rate for Payer: Health Smart Auto/Commercial	$3.13
Rate for Payer: Cash Price	$2.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.13
Rate for Payer: Aetna of CA Government/Medicare	$3.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.13
Rate for Payer: LLUH Dept of Risk Management WC	$2.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.91

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]

Facility

IP

$8.70

Service Code	NDC 0574-4024-11
Hospital Charge Code	1740239
Hospital Revenue Code	259
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$6.96
Rate for Payer: Cash Price	$3.92
Rate for Payer: Cigna of CA HMO/PPO	$6.96
Rate for Payer: Health Smart Auto/Commercial	$5.22
Rate for Payer: LLUH Dept of Risk Management WC	$4.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.52

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]

Facility

IP

$8.70

Service Code	NDC 0574-4024-50
Hospital Charge Code	1740239
Hospital Revenue Code	259
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$6.96
Rate for Payer: Cash Price	$3.92
Rate for Payer: Cigna of CA HMO/PPO	$6.96
Rate for Payer: Health Smart Auto/Commercial	$5.22
Rate for Payer: LLUH Dept of Risk Management WC	$4.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.52

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]

Facility

OP

$8.70

Service Code	NDC 0574-4024-50
Hospital Charge Code	1740239
Hospital Revenue Code	259
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$6.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.22
Rate for Payer: Aetna of CA Government/Medicare	$5.22
Rate for Payer: Cash Price	$3.92
Rate for Payer: Health Smart Auto/Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.22
Rate for Payer: LLUH Dept of Risk Management WC	$4.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.52

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]

Facility

OP

$5.13

Service Code	NDC 0574-4024-39
Hospital Charge Code	1740208
Hospital Revenue Code	259
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.08
Rate for Payer: Aetna of CA Government/Medicare	$3.08
Rate for Payer: Cash Price	$2.31
Rate for Payer: Health Smart Auto/Commercial	$3.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.08
Rate for Payer: LLUH Dept of Risk Management WC	$2.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.85

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]

Facility

OP

$8.70

Service Code	NDC 0574-4024-11
Hospital Charge Code	1740239
Hospital Revenue Code	259
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$6.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.22
Rate for Payer: Aetna of CA Government/Medicare	$5.22
Rate for Payer: Cash Price	$3.92
Rate for Payer: Health Smart Auto/Commercial	$5.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.22
Rate for Payer: LLUH Dept of Risk Management WC	$4.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.52

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]

Facility

IP

$5.13

Service Code	NDC 0574-4024-39
Hospital Charge Code	1740208
Hospital Revenue Code	259
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$4.10
Rate for Payer: Cash Price	$2.31
Rate for Payer: Cigna of CA HMO/PPO	$4.10
Rate for Payer: Health Smart Auto/Commercial	$3.08
Rate for Payer: LLUH Dept of Risk Management WC	$2.82
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.85

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]

Facility

OP

$3.89

Service Code	NDC 62559-440-01
Hospital Charge Code	1715564
Hospital Revenue Code	259
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.33
Rate for Payer: Aetna of CA Government/Medicare	$2.33
Rate for Payer: Cash Price	$1.75
Rate for Payer: Health Smart Auto/Commercial	$2.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.33
Rate for Payer: LLUH Dept of Risk Management WC	$2.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.92

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]

Facility

IP

$3.91

Service Code	NDC 52536-134-13
Hospital Charge Code	1715564
Hospital Revenue Code	259
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$3.13
Rate for Payer: Cash Price	$1.76
Rate for Payer: Cigna of CA HMO/PPO	$3.13
Rate for Payer: Health Smart Auto/Commercial	$2.35
Rate for Payer: LLUH Dept of Risk Management WC	$2.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.93

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]

Facility

IP

$3.89

Service Code	NDC 62559-440-01
Hospital Charge Code	1715564
Hospital Revenue Code	259
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$3.11
Rate for Payer: Cash Price	$1.75
Rate for Payer: Cigna of CA HMO/PPO	$3.11
Rate for Payer: Health Smart Auto/Commercial	$2.33
Rate for Payer: LLUH Dept of Risk Management WC	$2.14
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.92

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]

Facility

OP

$3.91

Service Code	NDC 52536-134-13
Hospital Charge Code	1715564
Hospital Revenue Code	259
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.35
Rate for Payer: Aetna of CA Government/Medicare	$2.35
Rate for Payer: Cash Price	$1.76
Rate for Payer: Health Smart Auto/Commercial	$2.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.35
Rate for Payer: LLUH Dept of Risk Management WC	$2.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.93

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