|
ERYTHROMYCIN 250 MG TAB
|
Facility
|
OP
|
$2.46
|
|
| Hospital Charge Code |
41653783
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.23
|
| Rate for Payer: Aetna Government |
$1.23
|
| Rate for Payer: Brighton Health Commercial |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.60
|
|
|
ERYTHROMYCIN 250 MG TAB
|
Facility
|
OP
|
$2.46
|
|
| Hospital Charge Code |
41643783
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.23
|
| Rate for Payer: Aetna Government |
$1.23
|
| Rate for Payer: Brighton Health Commercial |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.60
|
|
|
ERYTHROMYCIN 2 % EX SOLN [2887]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 45802003846
|
| Hospital Charge Code |
45802003846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
|
ERYTHROMYCIN 2 % EX SOLN [2887]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 42571038425
|
| Hospital Charge Code |
42571038425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
|
ERYTHROMYCIN 2% TOPICAL SOLN 60 ML
|
Facility
|
OP
|
$10.86
|
|
| Hospital Charge Code |
41652538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.43
|
| Rate for Payer: Aetna Government |
$5.43
|
| Rate for Payer: Brighton Health Commercial |
$8.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.38
|
| Rate for Payer: Group Health Inc Commercial |
$5.43
|
| Rate for Payer: Group Health Inc Medicare |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.06
|
|
|
ERYTHROMYCIN 2% TOPICAL SOLN 60 ML
|
Facility
|
OP
|
$10.86
|
|
| Hospital Charge Code |
41642538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.43
|
| Rate for Payer: Aetna Government |
$5.43
|
| Rate for Payer: Brighton Health Commercial |
$8.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.38
|
| Rate for Payer: Group Health Inc Commercial |
$5.43
|
| Rate for Payer: Group Health Inc Medicare |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.06
|
|
|
ERYTHROMYCIN 500 MG INJ
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41644363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
|
|
ERYTHROMYCIN 500 MG INJ
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41644363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.63 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Government |
$98.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$68.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$68.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$68.63
|
| Rate for Payer: Brighton Health Commercial |
$99.00
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$98.04
|
| Rate for Payer: EmblemHealth Commercial |
$98.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.94
|
| Rate for Payer: Group Health Inc Commercial |
$98.04
|
| Rate for Payer: Group Health Inc Medicare |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.33
|
| Rate for Payer: Healthfirst QHP |
$98.04
|
| Rate for Payer: Humana Medicare |
$100.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.52
|
| Rate for Payer: SOMOS Essential |
$82.52
|
| Rate for Payer: United Healthcare Commercial |
$83.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.43
|
| Rate for Payer: Wellcare Medicare |
$93.14
|
|
|
ERYTHROMYCIN 500 MG INJ
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41654363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.63 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Government |
$98.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$68.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$68.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$68.63
|
| Rate for Payer: Brighton Health Commercial |
$99.00
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$98.04
|
| Rate for Payer: EmblemHealth Commercial |
$98.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.94
|
| Rate for Payer: Group Health Inc Commercial |
$98.04
|
| Rate for Payer: Group Health Inc Medicare |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.33
|
| Rate for Payer: Healthfirst QHP |
$98.04
|
| Rate for Payer: Humana Medicare |
$100.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.52
|
| Rate for Payer: SOMOS Essential |
$82.52
|
| Rate for Payer: United Healthcare Commercial |
$83.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.43
|
| Rate for Payer: Wellcare Medicare |
$93.14
|
|
|
ERYTHROMYCIN 500 MG INJ
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41654363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
|
|
ERYTHROMYCIN 5 MG/GM OP OINT [2888]
|
Facility
|
OP
|
$5.43
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
24208091055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.71
|
| Rate for Payer: Aetna Government |
$2.71
|
| Rate for Payer: Brighton Health Commercial |
$4.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.69
|
| Rate for Payer: Group Health Inc Commercial |
$2.71
|
| Rate for Payer: Group Health Inc Medicare |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.53
|
|
|
ERYTHROMYCIN 5 MG/GM OP OINT [2888]
|
Facility
|
OP
|
$5.13
|
|
|
Service Code
|
NDC 00574402435
|
| Hospital Charge Code |
00574402435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.57
|
| Rate for Payer: Aetna Government |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$3.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.49
|
| Rate for Payer: Group Health Inc Commercial |
$2.57
|
| Rate for Payer: Group Health Inc Medicare |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.34
|
|
|
ERYTHROMYCIN 5 MG/GM OP OINT [2888]
|
Facility
|
OP
|
$12.14
|
|
|
Service Code
|
NDC 33261079501
|
| Hospital Charge Code |
33261079501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.07
|
| Rate for Payer: Aetna Government |
$6.07
|
| Rate for Payer: Brighton Health Commercial |
$9.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.26
|
| Rate for Payer: Group Health Inc Commercial |
$6.07
|
| Rate for Payer: Group Health Inc Medicare |
$4.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.89
|
|
|
ERYTHROMYCIN 5 MG/GM OP OINT [2888]
|
Facility
|
OP
|
$12.42
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
24208091019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.21
|
| Rate for Payer: Aetna Government |
$6.21
|
| Rate for Payer: Brighton Health Commercial |
$9.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.44
|
| Rate for Payer: Group Health Inc Commercial |
$6.21
|
| Rate for Payer: Group Health Inc Medicare |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.07
|
|
|
ERYTHROMYCIN 5 MG/GM OP OINT [2888]
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 00574402450
|
| Hospital Charge Code |
00574402450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.35
|
| Rate for Payer: Aetna Government |
$4.35
|
| Rate for Payer: Brighton Health Commercial |
$6.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.91
|
| Rate for Payer: Group Health Inc Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.65
|
|
|
ERYTHROMYCIN 5 MG/ML INJ PEDIATRIC
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41654364
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
ERYTHROMYCIN 5 MG/ML INJ PEDIATRIC
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41644364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$102.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Government |
$98.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$68.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$68.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$68.63
|
| Rate for Payer: Brighton Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$98.04
|
| Rate for Payer: EmblemHealth Commercial |
$98.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.94
|
| Rate for Payer: Group Health Inc Commercial |
$98.04
|
| Rate for Payer: Group Health Inc Medicare |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.33
|
| Rate for Payer: Healthfirst QHP |
$98.04
|
| Rate for Payer: Humana Medicare |
$100.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.52
|
| Rate for Payer: SOMOS Essential |
$82.52
|
| Rate for Payer: United Healthcare Commercial |
$83.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.43
|
| Rate for Payer: Wellcare Medicare |
$93.14
|
|
|
ERYTHROMYCIN 5 MG/ML INJ PEDIATRIC
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41644364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
ERYTHROMYCIN BASE 250MG CAPSULE
|
Facility
|
OP
|
$11.97
|
|
| Hospital Charge Code |
41646615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.98
|
| Rate for Payer: Aetna Government |
$5.98
|
| Rate for Payer: Brighton Health Commercial |
$8.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.98
|
| Rate for Payer: Group Health Inc Medicare |
$4.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.78
|
|
|
ERYTHROMYCIN BASE 250MG CAPSULE
|
Facility
|
OP
|
$11.97
|
|
| Hospital Charge Code |
41656615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.98
|
| Rate for Payer: Aetna Government |
$5.98
|
| Rate for Payer: Brighton Health Commercial |
$8.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.98
|
| Rate for Payer: Group Health Inc Medicare |
$4.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.78
|
|
|
ERYTHROMYCIN BASE 250 MG PO CPEP [28189]
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 68308025010
|
| Hospital Charge Code |
68308025010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.60
|
| Rate for Payer: Aetna Government |
$4.60
|
| Rate for Payer: Brighton Health Commercial |
$6.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.25
|
| Rate for Payer: Group Health Inc Commercial |
$4.60
|
| Rate for Payer: Group Health Inc Medicare |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.98
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 40 MG/ML SUS
|
Facility
|
OP
|
$1.38
|
|
| Hospital Charge Code |
41655223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Brighton Health Commercial |
$1.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.94
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 40 MG/ML SUS
|
Facility
|
OP
|
$1.38
|
|
| Hospital Charge Code |
41645223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Brighton Health Commercial |
$1.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.94
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR [2903]
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
14789011605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.43 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Government |
$98.04
|
| Rate for Payer: Brighton Health Commercial |
$144.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$98.04
|
| Rate for Payer: EmblemHealth Commercial |
$120.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.04
|
| Rate for Payer: Group Health Inc Commercial |
$98.04
|
| Rate for Payer: Group Health Inc Medicare |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.33
|
| Rate for Payer: Healthfirst QHP |
$98.04
|
| Rate for Payer: Humana Medicare |
$100.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.43
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR [2903]
|
Facility
|
OP
|
$109.06
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
00409648201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Government |
$98.04
|
| Rate for Payer: Brighton Health Commercial |
$65.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$98.04
|
| Rate for Payer: EmblemHealth Commercial |
$54.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.04
|
| Rate for Payer: Group Health Inc Commercial |
$98.04
|
| Rate for Payer: Group Health Inc Medicare |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.33
|
| Rate for Payer: Healthfirst QHP |
$98.04
|
| Rate for Payer: Humana Medicare |
$100.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.43
|
|
