Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHLORPHEN PHENTOL PE PPA DROPS

Facility

$138.25

Hospital Charge Code	60628909
Hospital Revenue Code	250
Min. Negotiated Rate	$20.74
Max. Negotiated Rate	$20.74
Rate for Payer: Qualcare PPO/HMO/WC	$20.74

CHLORPHEN PHENTOL PE PPA DROPS

Facility

$138.25

Hospital Charge Code	60628909
Hospital Revenue Code	250
Min. Negotiated Rate	$17.97
Max. Negotiated Rate	$69.12
Rate for Payer: Aetna Commercial	$41.48
Rate for Payer: Aetna Medicare Advantage	$41.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.25
Rate for Payer: Cigna Commercial	$69.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.97
Rate for Payer: Oxford Commercial	$69.12
Rate for Payer: Qualcare PPO/HMO/WC	$20.74
Rate for Payer: UnitedHealthcare Commercial	$69.12

CHLORPROMAZINE 100 MG TAB

Facility

$149.01

Service Code	NDC 51079051620
Hospital Charge Code	60627787
Hospital Revenue Code	250
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

CHLORPROMAZINE 100 MG TAB

Facility

$149.01

Service Code	NDC 51079051620
Hospital Charge Code	60627787
Hospital Revenue Code	250
Min. Negotiated Rate	$19.37
Max. Negotiated Rate	$74.50
Rate for Payer: Aetna Commercial	$44.70
Rate for Payer: Aetna Medicare Advantage	$44.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.00
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.37
Rate for Payer: Oxford Commercial	$74.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$74.50

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	$6.66
Max. Negotiated Rate	$22.21
Rate for Payer: Aetna Commercial	$13.33
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

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 200 MG TAB

Facility

$3.25

Hospital Charge Code	60627790
Hospital Revenue Code	636
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$0.98
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

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 200MG TABLET

Facility

$177.68

Service Code	NDC 51079051720
Hospital Charge Code	60631237
Hospital Revenue Code	250
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$88.84
Rate for Payer: Aetna Commercial	$53.30
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	$23.10
Rate for Payer: Oxford Commercial	$88.84
Rate for Payer: Qualcare PPO/HMO/WC	$26.65
Rate for Payer: UnitedHealthcare Commercial	$88.84

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	$3.45
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
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

CHLORPROMAZINE 25 MG/ML INJ

Facility

$154.37

Service Code	HCPCS J3230
Hospital Charge Code	60627794
Hospital Revenue Code	636
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$46.31
Rate for Payer: Aetna Commercial	$46.31
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	$20.96
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	$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 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	$9.61
Max. Negotiated Rate	$32.02
Rate for Payer: Aetna Commercial	$19.21
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

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	$46.33
Rate for Payer: Aetna Commercial	$27.80
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

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 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 AMP 50MG

Facility

$3.00

Hospital Charge Code	6012371
Hospital Revenue Code	251
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

CHLORPROMAZINE LEVEL

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000776
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.18
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	$8.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$0.32
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

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

Know your out-of-pocket cost for care.

All Charges