|
CHLORPROMAZINE HCL 25 MG/ML IJ SOLN
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
0641139731
|
|
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 |
$27.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.58
|
| Rate for Payer: EmblemHealth Commercial |
$17.34
|
| Rate for Payer: Group Health Inc Commercial |
$17.34
|
| Rate for Payer: Group Health Inc Medicare |
$12.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.54
|
|
|
CHLORPROMAZINE HCL 25 MG/ML IJ SOLN
|
Facility
|
IP
|
$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
|
IP
|
$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
|
OP
|
$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
|
OP
|
$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 PO TABS
|
Facility
|
OP
|
$7.64
|
|
|
Service Code
|
NDC 7071011301
|
| Hospital Charge Code |
7071011301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$6.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Brighton Health Commercial |
$5.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.20
|
| Rate for Payer: EmblemHealth Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Medicare |
$2.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.97
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
OP
|
$7.49
|
|
|
Service Code
|
NDC 5026816315
|
| Hospital Charge Code |
5026816315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.74
|
| Rate for Payer: Aetna Government |
$3.74
|
| Rate for Payer: Brighton Health Commercial |
$5.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.09
|
| Rate for Payer: EmblemHealth Commercial |
$3.74
|
| Rate for Payer: Group Health Inc Commercial |
$3.74
|
| Rate for Payer: Group Health Inc Medicare |
$2.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.87
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
IP
|
$11.08
|
|
|
Service Code
|
NDC 0832030101
|
| Hospital Charge Code |
0832030101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.54
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
IP
|
$7.49
|
|
|
Service Code
|
NDC 5026816311
|
| Hospital Charge Code |
5026816311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.74
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
NDC 0904713061
|
| Hospital Charge Code |
0904713061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
NDC 0904713061
|
| Hospital Charge Code |
0904713061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.12
|
| Rate for Payer: Aetna Government |
$3.12
|
| Rate for Payer: Brighton Health Commercial |
$4.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.25
|
| Rate for Payer: EmblemHealth Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
IP
|
$7.49
|
|
|
Service Code
|
NDC 5026816315
|
| Hospital Charge Code |
5026816315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.74
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
OP
|
$11.08
|
|
|
Service Code
|
NDC 0832030101
|
| Hospital Charge Code |
0832030101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.54
|
| Rate for Payer: Aetna Government |
$5.54
|
| Rate for Payer: Brighton Health Commercial |
$8.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.53
|
| Rate for Payer: EmblemHealth Commercial |
$5.54
|
| Rate for Payer: Group Health Inc Commercial |
$5.54
|
| Rate for Payer: Group Health Inc Medicare |
$3.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.20
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
IP
|
$7.64
|
|
|
Service Code
|
NDC 7071011301
|
| Hospital Charge Code |
7071011301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS
|
Facility
|
OP
|
$7.49
|
|
|
Service Code
|
NDC 5026816311
|
| Hospital Charge Code |
5026816311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.74
|
| Rate for Payer: Aetna Government |
$3.74
|
| Rate for Payer: Brighton Health Commercial |
$5.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.09
|
| Rate for Payer: EmblemHealth Commercial |
$3.74
|
| Rate for Payer: Group Health Inc Commercial |
$3.74
|
| Rate for Payer: Group Health Inc Medicare |
$2.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.87
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
5515031925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.93
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
0641139835
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.93
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$17.16
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
4359814111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$8.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.58
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$12.60
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
6679425002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Brighton Health Commercial |
$9.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$6.30
|
| Rate for Payer: Group Health Inc Commercial |
$6.30
|
| Rate for Payer: Group Health Inc Medicare |
$4.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.19
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$17.16
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
7071018507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$8.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.58
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
0641139835
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Brighton Health Commercial |
$14.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.51
|
| Rate for Payer: EmblemHealth Commercial |
$9.93
|
| Rate for Payer: Group Health Inc Commercial |
$9.93
|
| Rate for Payer: Group Health Inc Medicare |
$6.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.91
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
5515031901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Brighton Health Commercial |
$14.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.50
|
| Rate for Payer: EmblemHealth Commercial |
$9.93
|
| Rate for Payer: Group Health Inc Commercial |
$9.93
|
| Rate for Payer: Group Health Inc Medicare |
$6.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.91
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$12.60
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
6679425002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.30
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$17.16
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
4359814111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Brighton Health Commercial |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.67
|
| Rate for Payer: EmblemHealth Commercial |
$8.58
|
| Rate for Payer: Group Health Inc Commercial |
$8.58
|
| Rate for Payer: Group Health Inc Medicare |
$6.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.15
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
5515031925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Brighton Health Commercial |
$14.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.50
|
| Rate for Payer: EmblemHealth Commercial |
$9.93
|
| Rate for Payer: Group Health Inc Commercial |
$9.93
|
| Rate for Payer: Group Health Inc Medicare |
$6.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.91
|
|
