|
CHLORPROMAZINE 50 MG TAB
|
Facility
|
IP
|
$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
|
|
|
CHLORPROMAZINE 50 MG TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650597
|
|
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
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640597
|
|
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 HCL 100 MG PO TABS [1654]
|
Facility
|
OP
|
$14.98
|
|
|
Service Code
|
NDC 00904713261
|
| Hospital Charge Code |
00904713261
|
|
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: 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 100 MG PO TABS [1654]
|
Facility
|
OP
|
$14.89
|
|
|
Service Code
|
NDC 00832030300
|
| Hospital Charge Code |
00832030300
|
|
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: 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 10 MG PO TABS [1653]
|
Facility
|
OP
|
$6.63
|
|
|
Service Code
|
NDC 51079051820
|
| Hospital Charge Code |
51079051820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.31
|
| Rate for Payer: Aetna Government |
$3.31
|
| Rate for Payer: Brighton Health Commercial |
$4.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.51
|
| Rate for Payer: Group Health Inc Commercial |
$3.31
|
| Rate for Payer: Group Health Inc Medicare |
$2.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.31
|
|
|
CHLORPROMAZINE HCL 200 MG PO TABS [1655]
|
Facility
|
OP
|
$18.31
|
|
|
Service Code
|
NDC 00904689661
|
| Hospital Charge Code |
00904689661
|
|
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: 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 [1655]
|
Facility
|
OP
|
$33.12
|
|
|
Service Code
|
NDC 00832602101
|
| Hospital Charge Code |
00832602101
|
|
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: 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 [1655]
|
Facility
|
OP
|
$20.17
|
|
|
Service Code
|
NDC 60687046301
|
| Hospital Charge Code |
60687046301
|
|
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 |
$10.08
|
| Rate for Payer: Aetna Government |
$10.08
|
| 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: Group Health Inc Commercial |
$10.08
|
| Rate for Payer: Group Health Inc Medicare |
$7.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.11
|
|
|
CHLORPROMAZINE HCL 200 MG PO TABS [1655]
|
Facility
|
OP
|
$22.84
|
|
|
Service Code
|
NDC 69238106201
|
| Hospital Charge Code |
69238106201
|
|
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: 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 [1655]
|
Facility
|
OP
|
$13.80
|
|
|
Service Code
|
NDC 00904713361
|
| Hospital Charge Code |
00904713361
|
|
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: 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 [1649]
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
00641139735
|
|
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.53
|
|
|
CHLORPROMAZINE HCL 25 MG/ML IJ SOLN [1649]
|
Facility
|
OP
|
$32.87
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
70710184907
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
|
|
CHLORPROMAZINE HCL 25 MG/ML IJ SOLN [1649]
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
55150031825
|
|
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.53
|
|
|
CHLORPROMAZINE HCL 25 MG/ML IJ SOLN [1649]
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
00641139731
|
|
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.54
|
|
|
CHLORPROMAZINE HCL 25 MG/ML IJ SOLN [1649]
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
55150031801
|
|
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.53
|
|
|
CHLORPROMAZINE HCL 25 MG PO TABS [1656]
|
Facility
|
OP
|
$7.49
|
|
|
Service Code
|
NDC 50268016315
|
| Hospital Charge Code |
50268016315
|
|
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: 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 [1656]
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
NDC 00904713061
|
| Hospital Charge Code |
00904713061
|
|
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: 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 [1656]
|
Facility
|
OP
|
$11.08
|
|
|
Service Code
|
NDC 00832030101
|
| Hospital Charge Code |
00832030101
|
|
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: 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 [1656]
|
Facility
|
OP
|
$7.49
|
|
|
Service Code
|
NDC 50268016311
|
| Hospital Charge Code |
50268016311
|
|
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: 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 [1656]
|
Facility
|
OP
|
$7.64
|
|
|
Service Code
|
NDC 70710113001
|
| Hospital Charge Code |
70710113001
|
|
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: 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 50 MG/2ML IJ SOLN [129677]
|
Facility
|
OP
|
$32.87
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
70710185007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.87
|
| Rate for Payer: Aetna Government |
$32.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN [129677]
|
Facility
|
OP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
00641139835
|
|
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.91
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN [129677]
|
Facility
|
OP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
55150031925
|
|
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 |
$13.50
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.91
|
|
|
CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN [129677]
|
Facility
|
OP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
55150031901
|
|
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 |
$13.50
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.91
|
|
