St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHLORPROMAZINE 100 MG TAB

Facility

$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

$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: Brighton Health Commercial	$0.60
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

$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: Brighton Health Commercial	$0.60
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

$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 10 MG TAB

Facility

$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: Brighton Health Commercial	$0.60
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

$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: Brighton Health Commercial	$0.60
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

$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

$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 200 MG TAB

Facility

$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

$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: Brighton Health Commercial	$0.60
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

$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

$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: Brighton Health Commercial	$0.60
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

$13.98

Service Code	HCPCS J3230
Hospital Charge Code	41641524
Hospital Revenue Code	636
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$32.87
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: Brighton Health Commercial	$8.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.04
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: 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

$13.98

Service Code	HCPCS J3230
Hospital Charge Code	41651524
Hospital Revenue Code	636
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$32.87
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: Brighton Health Commercial	$8.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.04
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: 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

$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

$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 2 ML

Facility

$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

$38.81

Service Code	HCPCS J3230
Hospital Charge Code	41651525
Hospital Revenue Code	636
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$32.87
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: Brighton Health Commercial	$23.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.32
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: 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

$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/ML INJ 2 ML

Facility

$38.81

Service Code	HCPCS J3230
Hospital Charge Code	41641525
Hospital Revenue Code	636
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$32.87
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: Brighton Health Commercial	$23.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.32
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: 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 TAB

Facility

$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: Brighton Health Commercial	$0.60
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

$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: Brighton Health Commercial	$0.60
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

$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

CHLORPROMAZINE 25 MG TAB

Facility

$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 50 MG TAB

Facility

$1.00

Service Code	HCPCS Q0161
Hospital Charge Code	41640597
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

Know your out-of-pocket cost for care.

All Charges