St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHLORPROMAZINE HCL 100 MG PO TABS

Facility

$14.89

Service Code	NDC 0832030300
Hospital Charge Code	0832030300
Hospital Revenue Code	250
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$11.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.44
Rate for Payer: Aetna Government	$7.44
Rate for Payer: Brighton Health Commercial	$11.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.12
Rate for Payer: EmblemHealth Commercial	$7.44
Rate for Payer: Group Health Inc Commercial	$7.44
Rate for Payer: Group Health Inc Medicare	$5.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.44
Rate for Payer: Hamaspik Choice Inc Medicare	$7.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.68

CHLORPROMAZINE HCL 100 MG PO TABS

Facility

$14.98

Service Code	NDC 0904713261
Hospital Charge Code	0904713261
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$11.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.49
Rate for Payer: Aetna Government	$7.49
Rate for Payer: Brighton Health Commercial	$11.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.19
Rate for Payer: EmblemHealth Commercial	$7.49
Rate for Payer: Group Health Inc Commercial	$7.49
Rate for Payer: Group Health Inc Medicare	$5.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.49
Rate for Payer: Hamaspik Choice Inc Medicare	$7.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.74

CHLORPROMAZINE HCL 10 MG PO TABS

Facility

$5.14

Service Code	NDC 5026816211
Hospital Charge Code	5026816211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$4.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.57
Rate for Payer: Aetna Government	$2.57
Rate for Payer: Brighton Health Commercial	$3.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.50
Rate for Payer: EmblemHealth Commercial	$2.57
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

CHLORPROMAZINE HCL 10 MG PO TABS

Facility

$5.14

Service Code	NDC 5026816211
Hospital Charge Code	5026816211
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$2.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.57

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$18.31

Service Code	NDC 0904689661
Hospital Charge Code	0904689661
Hospital Revenue Code	250
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$14.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.15
Rate for Payer: Aetna Government	$9.15
Rate for Payer: Brighton Health Commercial	$13.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.45
Rate for Payer: EmblemHealth Commercial	$9.15
Rate for Payer: Group Health Inc Commercial	$9.15
Rate for Payer: Group Health Inc Medicare	$6.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.15
Rate for Payer: Hamaspik Choice Inc Medicare	$9.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.90

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$33.12

Service Code	NDC 0832602101
Hospital Charge Code	0832602101
Hospital Revenue Code	250
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$26.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.56
Rate for Payer: Aetna Government	$16.56
Rate for Payer: Brighton Health Commercial	$24.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.52
Rate for Payer: EmblemHealth Commercial	$16.56
Rate for Payer: Group Health Inc Commercial	$16.56
Rate for Payer: Group Health Inc Medicare	$11.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56
Rate for Payer: Hamaspik Choice Inc Medicare	$16.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.53

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$22.84

Service Code	NDC 6923810621
Hospital Charge Code	6923810621
Hospital Revenue Code	250
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$11.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.42

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$13.80

Service Code	NDC 0904713361
Hospital Charge Code	0904713361
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.90

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$20.17

Service Code	NDC 6068746301
Hospital Charge Code	6068746301
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$16.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.09
Rate for Payer: Aetna Government	$10.09
Rate for Payer: Brighton Health Commercial	$15.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.72
Rate for Payer: EmblemHealth Commercial	$10.09
Rate for Payer: Group Health Inc Commercial	$10.09
Rate for Payer: Group Health Inc Medicare	$7.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.09
Rate for Payer: Hamaspik Choice Inc Medicare	$10.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.11

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$33.12

Service Code	NDC 0832602101
Hospital Charge Code	0832602101
Hospital Revenue Code	250
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$16.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$22.84

Service Code	NDC 6923810621
Hospital Charge Code	6923810621
Hospital Revenue Code	250
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$18.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.42
Rate for Payer: Aetna Government	$11.42
Rate for Payer: Brighton Health Commercial	$17.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.53
Rate for Payer: EmblemHealth Commercial	$11.42
Rate for Payer: Group Health Inc Commercial	$11.42
Rate for Payer: Group Health Inc Medicare	$7.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.42
Rate for Payer: Hamaspik Choice Inc Medicare	$11.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.85

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$18.31

Service Code	NDC 0904689661
Hospital Charge Code	0904689661
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.15

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$20.17

Service Code	NDC 6068746301
Hospital Charge Code	6068746301
Hospital Revenue Code	250
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.09

CHLORPROMAZINE HCL 200 MG PO TABS

Facility

$13.80

Service Code	NDC 0904713361
Hospital Charge Code	0904713361
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$11.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.90
Rate for Payer: Aetna Government	$6.90
Rate for Payer: Brighton Health Commercial	$10.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.38
Rate for Payer: EmblemHealth Commercial	$6.90
Rate for Payer: Group Health Inc Commercial	$6.90
Rate for Payer: Group Health Inc Medicare	$4.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.90
Rate for Payer: Hamaspik Choice Inc Medicare	$6.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.97

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$34.67

Service Code	HCPCS J3230
Hospital Charge Code	5515031801
Hospital Revenue Code	250
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$17.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.33

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$20.93

Service Code	HCPCS J3230
Hospital Charge Code	6521912800
Hospital Revenue Code	250
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$32.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.87
Rate for Payer: Aetna Government	$32.87
Rate for Payer: Brighton Health Commercial	$15.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.23
Rate for Payer: EmblemHealth Commercial	$10.46
Rate for Payer: Group Health Inc Commercial	$10.46
Rate for Payer: Group Health Inc Medicare	$7.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.46
Rate for Payer: Hamaspik Choice Inc Medicare	$10.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.60

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$20.93

Service Code	HCPCS J3230
Hospital Charge Code	6521912800
Hospital Revenue Code	250
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$10.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.46

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$29.95

Service Code	HCPCS J3230
Hospital Charge Code	7071018491
Hospital Revenue Code	250
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$14.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.98

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$29.95

Service Code	HCPCS J3230
Hospital Charge Code	7071018491
Hospital Revenue Code	250
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$32.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.87
Rate for Payer: Aetna Government	$32.87
Rate for Payer: Brighton Health Commercial	$22.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.37
Rate for Payer: EmblemHealth Commercial	$14.98
Rate for Payer: Group Health Inc Commercial	$14.98
Rate for Payer: Group Health Inc Medicare	$10.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.98
Rate for Payer: Hamaspik Choice Inc Medicare	$14.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.47

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$34.67

Service Code	HCPCS J3230
Hospital Charge Code	0641139735
Hospital Revenue Code	250
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$32.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.87
Rate for Payer: Aetna Government	$32.87
Rate for Payer: Brighton Health Commercial	$26.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.57
Rate for Payer: EmblemHealth Commercial	$17.33
Rate for Payer: Group Health Inc Commercial	$17.33
Rate for Payer: Group Health Inc Medicare	$12.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.33
Rate for Payer: Hamaspik Choice Inc Medicare	$17.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.53

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$34.67

Service Code	HCPCS J3230
Hospital Charge Code	5515031801
Hospital Revenue Code	250
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$32.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.87
Rate for Payer: Aetna Government	$32.87
Rate for Payer: Brighton Health Commercial	$26.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.57
Rate for Payer: EmblemHealth Commercial	$17.33
Rate for Payer: Group Health Inc Commercial	$17.33
Rate for Payer: Group Health Inc Medicare	$12.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.33
Rate for Payer: Hamaspik Choice Inc Medicare	$17.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.53

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$29.90

Service Code	HCPCS J3230
Hospital Charge Code	6679424902
Hospital Revenue Code	250
Min. Negotiated Rate	$10.47
Max. Negotiated Rate	$32.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.87
Rate for Payer: Aetna Government	$32.87
Rate for Payer: Brighton Health Commercial	$22.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.33
Rate for Payer: EmblemHealth Commercial	$14.95
Rate for Payer: Group Health Inc Commercial	$14.95
Rate for Payer: Group Health Inc Medicare	$10.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.95
Rate for Payer: Hamaspik Choice Inc Medicare	$14.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.44

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$29.90

Service Code	HCPCS J3230
Hospital Charge Code	6679424902
Hospital Revenue Code	250
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$14.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.95

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$29.95

Service Code	HCPCS J3230
Hospital Charge Code	4359814011
Hospital Revenue Code	250
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$14.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.98

CHLORPROMAZINE HCL 25 MG/ML IJ SOLN

Facility

$34.67

Service Code	HCPCS J3230
Hospital Charge Code	0641139735
Hospital Revenue Code	250
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$17.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.33

Know your out-of-pocket cost for care.

All Charges