St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ERIBULIN 1MG/2ML INJ

Facility

$258.50

Service Code	HCPCS J9179
Hospital Charge Code	41656650
Hospital Revenue Code	636
Min. Negotiated Rate	$102.95
Max. Negotiated Rate	$10,295.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.02
Rate for Payer: Aetna Government	$134.02
Rate for Payer: Affinity Essential Plan 1&2	$231.64
Rate for Payer: Affinity Essential Plan 3&4	$231.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$102.95
Rate for Payer: Amida Care Medicaid	$102.95
Rate for Payer: Brighton Health Commercial	$155.10
Rate for Payer: Cash Price	$134.02
Rate for Payer: Cash Price	$134.02
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$134.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$148.64
Rate for Payer: Elderplan Medicare Advantage	$134.02
Rate for Payer: EmblemHealth Commercial	$134.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10,295.00
Rate for Payer: Fidelis Essential Plan Aliesa	$102.95
Rate for Payer: Fidelis Essential Plan QHP	$102.95
Rate for Payer: Fidelis Medicare Advantage	$134.02
Rate for Payer: Fidelis Qualified Health Plan	$108.10
Rate for Payer: Group Health Inc Commercial	$134.02
Rate for Payer: Group Health Inc Medicare	$134.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.95
Rate for Payer: Hamaspik Choice Inc Medicare	$129.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$102.95
Rate for Payer: Healthfirst Essential Plan	$231.64
Rate for Payer: Healthfirst Medicare Advantage	$113.91
Rate for Payer: Healthfirst QHP	$102.95
Rate for Payer: Humana Medicare	$136.70
Rate for Payer: Senior Whole Health Medicare Advantage	$134.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.95
Rate for Payer: SOMOS Essential	$102.95
Rate for Payer: United Healthcare Commercial	$126.63
Rate for Payer: United Healthcare Essential Plan 1&2	$231.64
Rate for Payer: United Healthcare Essential Plan 3&4	$113.24
Rate for Payer: United Healthcare Medicaid	$102.95
Rate for Payer: United Healthcare Medicare Advantage	$134.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$107.21
Rate for Payer: Wellcare Medicare	$127.32

ERIBULIN 1MG/2ML INJ

Facility

$258.50

Service Code	HCPCS J9179
Hospital Charge Code	41656650
Hospital Revenue Code	636
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$129.25
Rate for Payer: Cash Price	$134.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.25
Rate for Payer: Hamaspik Choice Inc Medicare	$129.25

ERIBULIN MESYLATE 1 MG/2ML IV SOLN [106773]

Facility

$846.00

Service Code	HCPCS J9179
Hospital Charge Code	62856038901
Hospital Revenue Code	278
Min. Negotiated Rate	$102.95
Max. Negotiated Rate	$10,295.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$465.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.02
Rate for Payer: Aetna Government	$134.02
Rate for Payer: Affinity Essential Plan 1&2	$231.64
Rate for Payer: Affinity Essential Plan 3&4	$231.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$102.95
Rate for Payer: Amida Care Medicaid	$102.95
Rate for Payer: Brighton Health Commercial	$507.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$134.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$423.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$486.45
Rate for Payer: Elderplan Medicare Advantage	$134.02
Rate for Payer: EmblemHealth Commercial	$423.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10,295.00
Rate for Payer: Fidelis Essential Plan Aliesa	$102.95
Rate for Payer: Fidelis Essential Plan QHP	$102.95
Rate for Payer: Fidelis Medicare Advantage	$134.02
Rate for Payer: Fidelis Qualified Health Plan	$108.10
Rate for Payer: Group Health Inc Commercial	$134.02
Rate for Payer: Group Health Inc Medicare	$134.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.95
Rate for Payer: Hamaspik Choice Inc Medicare	$423.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$102.95
Rate for Payer: Healthfirst Essential Plan	$231.64
Rate for Payer: Healthfirst Medicare Advantage	$113.91
Rate for Payer: Healthfirst QHP	$102.95
Rate for Payer: Humana Medicare	$136.70
Rate for Payer: Senior Whole Health Medicare Advantage	$134.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$102.95
Rate for Payer: SOMOS Essential	$102.95
Rate for Payer: United Healthcare Essential Plan 1&2	$231.64
Rate for Payer: United Healthcare Essential Plan 3&4	$113.24
Rate for Payer: United Healthcare Medicaid	$102.95
Rate for Payer: United Healthcare Medicare Advantage	$134.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$549.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$107.21

ERIBULIN MESYLATE 1 MG/2ML IV SOLN [106773]

Facility

$846.00

Service Code	HCPCS J9179
Hospital Charge Code	62856038901
Hospital Revenue Code	278
Min. Negotiated Rate	$423.00
Max. Negotiated Rate	$423.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$423.00
Rate for Payer: Hamaspik Choice Inc Medicare	$423.00

ERSD SERV 4 VISITS P MO<2YR

Facility

$2,759.33

Service Code	HCPCS 90951
Hospital Charge Code	30306406
Hospital Revenue Code	510
Min. Negotiated Rate	$173.89
Max. Negotiated Rate	$1,517.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,517.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$809.51
Rate for Payer: Aetna Government	$809.51
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,379.66
Rate for Payer: Hamaspik Choice Inc Medicare	$1,379.66
Rate for Payer: United Healthcare Commercial	$222.00

ERTAPENEM 1G/LIDOCAINE 1% INJ

Facility

$160.18

Service Code	HCPCS J1335
Hospital Charge Code	41647844
Hospital Revenue Code	636
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$104.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$96.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.10
Rate for Payer: Group Health Inc Commercial	$80.09
Rate for Payer: Group Health Inc Medicare	$56.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.09
Rate for Payer: Hamaspik Choice Inc Medicare	$80.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.61
Rate for Payer: SOMOS Essential	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$104.12

ERTAPENEM 1G/LIDOCAINE 1% INJ

Facility

$160.18

Service Code	HCPCS J1335
Hospital Charge Code	41647844
Hospital Revenue Code	636
Min. Negotiated Rate	$80.09
Max. Negotiated Rate	$80.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.09
Rate for Payer: Hamaspik Choice Inc Medicare	$80.09

ERTAPENEM 1G/LIDOCAINE 1% INJ

Facility

$160.18

Service Code	HCPCS J1335
Hospital Charge Code	41657844
Hospital Revenue Code	636
Min. Negotiated Rate	$80.09
Max. Negotiated Rate	$80.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.09
Rate for Payer: Hamaspik Choice Inc Medicare	$80.09

ERTAPENEM 1G/LIDOCAINE 1% INJ

Facility

$160.18

Service Code	HCPCS J1335
Hospital Charge Code	41657844
Hospital Revenue Code	636
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$104.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$96.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.10
Rate for Payer: Group Health Inc Commercial	$80.09
Rate for Payer: Group Health Inc Medicare	$56.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.09
Rate for Payer: Hamaspik Choice Inc Medicare	$80.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.61
Rate for Payer: SOMOS Essential	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$104.12

ERTAPENEM 1 GRAM INJ

Facility

$70.01

Service Code	HCPCS J1335
Hospital Charge Code	41643153
Hospital Revenue Code	636
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00

ERTAPENEM 1 GRAM INJ

Facility

$70.01

Service Code	HCPCS J1335
Hospital Charge Code	41653153
Hospital Revenue Code	636
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00

ERTAPENEM 1 GRAM INJ

Facility

$70.01

Service Code	HCPCS J1335
Hospital Charge Code	41653153
Hospital Revenue Code	636
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$45.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$42.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.26
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.61
Rate for Payer: SOMOS Essential	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.51

ERTAPENEM 1 GRAM INJ

Facility

$70.01

Service Code	HCPCS J1335
Hospital Charge Code	41643153
Hospital Revenue Code	636
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$45.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$42.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.26
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.61
Rate for Payer: SOMOS Essential	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.51

ERTAPENEM 312.5 MG/ML IN LIDOCAINE 1% IM INJ-COMPOUNDED [700525]

Facility

$28.24

Service Code	HCPCS J1335
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$28.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$11.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$12.61
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$12.61
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$12.61

ERTAPENEM 500 MG INJ

Facility

$106.25

Service Code	HCPCS J1335
Hospital Charge Code	41650301
Hospital Revenue Code	636
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$69.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$63.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.09
Rate for Payer: Group Health Inc Commercial	$53.12
Rate for Payer: Group Health Inc Medicare	$37.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.12
Rate for Payer: Hamaspik Choice Inc Medicare	$53.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.61
Rate for Payer: SOMOS Essential	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.06

ERTAPENEM 500 MG INJ

Facility

$106.25

Service Code	HCPCS J1335
Hospital Charge Code	41640301
Hospital Revenue Code	636
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$69.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$63.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.09
Rate for Payer: Group Health Inc Commercial	$53.12
Rate for Payer: Group Health Inc Medicare	$37.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.12
Rate for Payer: Hamaspik Choice Inc Medicare	$53.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.61
Rate for Payer: SOMOS Essential	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.06

ERTAPENEM 500 MG INJ

Facility

$106.25

Service Code	HCPCS J1335
Hospital Charge Code	41640301
Hospital Revenue Code	636
Min. Negotiated Rate	$53.12
Max. Negotiated Rate	$53.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.12
Rate for Payer: Hamaspik Choice Inc Medicare	$53.12

ERTAPENEM 500 MG INJ

Facility

$106.25

Service Code	HCPCS J1335
Hospital Charge Code	41650301
Hospital Revenue Code	636
Min. Negotiated Rate	$53.12
Max. Negotiated Rate	$53.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.12
Rate for Payer: Hamaspik Choice Inc Medicare	$53.12

ERTAPENEM SODIUM 1 G IJ SOLR [31922]

Facility

$72.00

Service Code	HCPCS J1335
Hospital Charge Code	55150028220
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$57.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$54.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.96
Rate for Payer: Group Health Inc Commercial	$36.00
Rate for Payer: Group Health Inc Medicare	$25.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00
Rate for Payer: Hamaspik Choice Inc Medicare	$36.00
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$11.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$12.61
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$12.61
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.80

ERTAPENEM SODIUM 1 G IJ SOLR [31922]

Facility

$140.48

Service Code	HCPCS J1335
Hospital Charge Code	42023022110
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$112.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$105.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.53
Rate for Payer: Group Health Inc Commercial	$70.24
Rate for Payer: Group Health Inc Medicare	$49.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.24
Rate for Payer: Hamaspik Choice Inc Medicare	$70.24
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$11.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$12.61
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$12.61
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$91.31

ERTAPENEM SODIUM 1 G IJ SOLR [31922]

Facility

$140.48

Service Code	HCPCS J1335
Hospital Charge Code	42023022101
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$112.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.24
Rate for Payer: Aetna Government	$28.24
Rate for Payer: Brighton Health Commercial	$105.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.53
Rate for Payer: Group Health Inc Commercial	$70.24
Rate for Payer: Group Health Inc Medicare	$49.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.24
Rate for Payer: Hamaspik Choice Inc Medicare	$70.24
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$11.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$12.61
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$12.61
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$12.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$91.31

ERYTHROMYCIN 0.5% OPHTHALMIC OINT 1 GRAM

Facility

$13.00

Hospital Charge Code	41651420
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

ERYTHROMYCIN 0.5% OPHTHALMIC OINT 1 GRAM

Facility

$13.00

Hospital Charge Code	41641420
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

ERYTHROMYCIN 0.5% OPHTHALMIC OINT 3.5 GR

Facility

$3.00

Hospital Charge Code	41650502
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

ERYTHROMYCIN 0.5% OPHTHALMIC OINT 3.5 GR

Facility

$3.00

Hospital Charge Code	41640502
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

Know your out-of-pocket cost for care.

All Charges