|
CHLORPHENIRAMINE 4 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 100 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 100 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 100 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 100 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 10 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 10 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 10 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 10 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 200 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 200 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 200 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 200 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 25 MG/ML INJ 1 ML
|
Facility
OP
|
$13.98
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
41641524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.36
|
| Rate for Payer: Group Health Inc Commercial |
$6.99
|
| Rate for Payer: Group Health Inc Medicare |
$4.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.61
|
| Rate for Payer: SOMOS Essential |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.09
|
|
|
CHLORPROMAZINE 25 MG/ML INJ 1 ML
|
Facility
IP
|
$13.98
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
41651524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.99
|
|
|
CHLORPROMAZINE 25 MG/ML INJ 1 ML
|
Facility
IP
|
$13.98
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
41641524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.99
|
|
|
CHLORPROMAZINE 25 MG/ML INJ 1 ML
|
Facility
OP
|
$13.98
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
41651524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.36
|
| Rate for Payer: Group Health Inc Commercial |
$6.99
|
| Rate for Payer: Group Health Inc Medicare |
$4.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.61
|
| Rate for Payer: SOMOS Essential |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.09
|
|
|
CHLORPROMAZINE 25 MG/ML INJ 2 ML
|
Facility
OP
|
$38.81
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
41641525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.36
|
| Rate for Payer: Group Health Inc Commercial |
$19.40
|
| Rate for Payer: Group Health Inc Medicare |
$13.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.61
|
| Rate for Payer: SOMOS Essential |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.23
|
|
|
CHLORPROMAZINE 25 MG/ML INJ 2 ML
|
Facility
OP
|
$38.81
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
41651525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.36
|
| Rate for Payer: Group Health Inc Commercial |
$19.40
|
| Rate for Payer: Group Health Inc Medicare |
$13.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.61
|
| Rate for Payer: SOMOS Essential |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.23
|
|
|
CHLORPROMAZINE 25 MG/ML INJ 2 ML
|
Facility
IP
|
$38.81
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
41641525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.40
|
|
|
CHLORPROMAZINE 25 MG/ML INJ 2 ML
|
Facility
IP
|
$38.81
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
41651525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.40
|
|
|
CHLORPROMAZINE 25 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 25 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 25 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CHLORPROMAZINE 25 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
