Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CHLORPROMAZINE 10 MG TAB

Facility

$44.42

Service Code	HCPCS Q0161
Hospital Charge Code	60627789
Hospital Revenue Code	636
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$10.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.66

CHLORPROMAZINE 10 MG TAB

Facility

$44.42

Service Code	HCPCS Q0161
Hospital Charge Code	60627789
Hospital Revenue Code	636
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$22.21
Rate for Payer: Aetna Commercial	$16.88
Rate for Payer: Aetna Medicare Advantage	$13.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.33
Rate for Payer: Cigna Commercial	$22.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.66
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.18

CHLORPROMAZINE 200 MG TAB

Facility

$3.25

Hospital Charge Code	60627790
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$1.24
Rate for Payer: Aetna Medicare Advantage	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.83
Rate for Payer: Cigna Commercial	$1.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

CHLORPROMAZINE 200 MG TAB

Facility

$3.25

Hospital Charge Code	60627790
Hospital Revenue Code	636
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.49

CHLORPROMAZINE 200MG TABLET

Facility

$177.68

Service Code	NDC 51079051720
Hospital Charge Code	60631237
Hospital Revenue Code	250
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$88.84
Rate for Payer: Aetna Commercial	$67.52
Rate for Payer: Aetna Medicare Advantage	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.31
Rate for Payer: Cigna Commercial	$88.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.30
Rate for Payer: Oxford Commercial	$35.54
Rate for Payer: Qualcare PPO/HMO/WC	$26.65
Rate for Payer: UnitedHealthcare Commercial	$35.54
Rate for Payer: UnitedHealthcare Community & State	$4.28
Rate for Payer: Wellpoint Medicaid Managed Care	$4.71

CHLORPROMAZINE 200MG TABLET

Facility

$177.68

Service Code	NDC 51079051720
Hospital Charge Code	60631237
Hospital Revenue Code	250
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$26.65
Rate for Payer: Qualcare PPO/HMO/WC	$26.65

CHLORPROMAZINE/25MG/1ML

Facility

$23.00

Hospital Charge Code	60632689
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

CHLORPROMAZINE/25MG/1ML

Facility

$23.00

Hospital Charge Code	60632689
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

CHLORPROMAZINE 25 MG/ML INJ

Facility

$154.37

Service Code	HCPCS J3230
Hospital Charge Code	60627794
Hospital Revenue Code	636
Min. Negotiated Rate	$23.16
Max. Negotiated Rate	$37.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.36
Rate for Payer: Qualcare PPO/HMO/WC	$23.16

CHLORPROMAZINE 25 MG/ML INJ

Facility

$154.37

Service Code	HCPCS J3230
Hospital Charge Code	60627794
Hospital Revenue Code	636
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$77.19
Rate for Payer: Aetna Commercial	$58.66
Rate for Payer: Aetna Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.36
Rate for Payer: Cigna Commercial	$77.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.36
Rate for Payer: Qualcare PPO/HMO/WC	$23.16
Rate for Payer: UnitedHealthcare Community & State	$3.72
Rate for Payer: Wellpoint Medicaid Managed Care	$4.09

CHLORPROMAZINE 25 MG TAB

Facility

$64.05

Service Code	HCPCS Q0161
Hospital Charge Code	60627791
Hospital Revenue Code	636
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.61

CHLORPROMAZINE 25 MG TAB

Facility

$64.05

Service Code	HCPCS Q0161
Hospital Charge Code	60627791
Hospital Revenue Code	636
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.02
Rate for Payer: Aetna Commercial	$24.34
Rate for Payer: Aetna Medicare Advantage	$19.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.33
Rate for Payer: Cigna Commercial	$32.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.61
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

CHLORPROMAZINE 50 MG TAB

Facility

$92.66

Service Code	HCPCS Q0161
Hospital Charge Code	60627793
Hospital Revenue Code	636
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$22.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.42
Rate for Payer: Qualcare PPO/HMO/WC	$13.90

CHLORPROMAZINE 50 MG TAB

Facility

$92.66

Service Code	HCPCS Q0161
Hospital Charge Code	60627793
Hospital Revenue Code	636
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$46.33
Rate for Payer: Aetna Commercial	$35.21
Rate for Payer: Aetna Medicare Advantage	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.63
Rate for Payer: Cigna Commercial	$46.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.42
Rate for Payer: Qualcare PPO/HMO/WC	$13.90
Rate for Payer: UnitedHealthcare Community & State	$2.23
Rate for Payer: Wellpoint Medicaid Managed Care	$2.46

CHLORPROMAZINE AMP 50MG

Facility

$3.00

Hospital Charge Code	6012371
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CHLORPROMAZINE AMP 50MG

Facility

$3.00

Hospital Charge Code	6012371
Hospital Revenue Code	251
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORPROMAZINE LEVEL

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000776
Hospital Revenue Code	301
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

CHLORPROMAZINE LEVEL

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000776
Hospital Revenue Code	301
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

CHLORPROMAZINE LQ 100MG/ML

Facility

$2.45

Hospital Charge Code	60627788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
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	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

CHLORPROMAZINE LQ 100MG/ML

Facility

$2.45

Hospital Charge Code	60627788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

CHLORPROMAZINE LQ 2MG/ML 4OZ

Facility

$34.60

Hospital Charge Code	6001176
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

CHLORPROMAZINE LQ 2MG/ML 4OZ

Facility

$34.60

Hospital Charge Code	6001176
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
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	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

CHLORPROMAZINE LQ 30MG/ML

Facility

$2.45

Hospital Charge Code	60627792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
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	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

CHLORPROMAZINE LQ 30MG/ML

Facility

$2.45

Hospital Charge Code	60627792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

CHLORPROMAZINE TAB 25MG

Facility

$1.95

Hospital Charge Code	6022354
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

Know your out-of-pocket cost for care.

All Charges