Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLONIDINE 0.1 MG TAB

Facility

$4.00

Service Code	NDC 51079029920
Hospital Charge Code	60627624
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CLONIDINE 0.1 MG TAB

Facility

$4.00

Service Code	NDC 51079029920
Hospital Charge Code	60627624
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CLONIDINE/0.1MG/TAB

Facility

$3.00

Hospital Charge Code	60632720
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CLONIDINE/0.1MG/TAB

Facility

$4.00

Hospital Charge Code	60632717
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CLONIDINE/0.1MG/TAB

Facility

$4.00

Hospital Charge Code	60632717
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CLONIDINE/0.1MG/TAB

Facility

$3.00

Hospital Charge Code	60632720
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CLONIDINE 0.1MG TAB(CATAPRES)

Facility

$4.00

Hospital Charge Code	83652557
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CLONIDINE 0.1MG TAB(CATAPRES)

Facility

$4.00

Hospital Charge Code	83652557
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CLONIDINE 0.2 MG TAB

Facility

$4.00

Service Code	NDC 51079030020
Hospital Charge Code	60627625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CLONIDINE 0.2 MG TAB

Facility

$4.00

Service Code	NDC 51079030020
Hospital Charge Code	60627625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CLONIDINE/0.2MG/TAB

Facility

$3.00

Hospital Charge Code	60632721
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CLONIDINE/0.2MG/TAB

Facility

$3.00

Hospital Charge Code	60632721
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CLONIDINE/0.2MG/TAB

Facility

$4.00

Hospital Charge Code	60632718
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CLONIDINE/0.2MG/TAB

Facility

$4.00

Hospital Charge Code	60632718
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CLONIDINE/0.3MG/TAB

Facility

$4.00

Service Code	NDC 904565861
Hospital Charge Code	60632719
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CLONIDINE/0.3MG/TAB

Facility

$4.00

Service Code	NDC 904565861
Hospital Charge Code	60632719
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CLONIDINE HCL PATCH 0.1MG

Facility

$221.90

Service Code	NDC 378087199
Hospital Charge Code	6001267
Hospital Revenue Code	250
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$110.95
Rate for Payer: Aetna Commercial	$84.32
Rate for Payer: Aetna Medicare Advantage	$66.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.58
Rate for Payer: Cigna Commercial	$110.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.57
Rate for Payer: Oxford Commercial	$44.38
Rate for Payer: Qualcare PPO/HMO/WC	$33.28
Rate for Payer: UnitedHealthcare Commercial	$44.38
Rate for Payer: UnitedHealthcare Community & State	$5.35
Rate for Payer: Wellpoint Medicaid Managed Care	$5.88

CLONIDINE HCL PATCH 0.1MG

Facility

$221.90

Service Code	NDC 378087199
Hospital Charge Code	6001267
Hospital Revenue Code	250
Min. Negotiated Rate	$33.28
Max. Negotiated Rate	$33.28
Rate for Payer: Qualcare PPO/HMO/WC	$33.28

CLONIDINE HCL PATCH 0.2MG

Facility

$262.77

Service Code	NDC 597003234
Hospital Charge Code	6001275
Hospital Revenue Code	250
Min. Negotiated Rate	$39.42
Max. Negotiated Rate	$39.42
Rate for Payer: Qualcare PPO/HMO/WC	$39.42

CLONIDINE HCL PATCH 0.2MG

Facility

$262.77

Service Code	NDC 597003234
Hospital Charge Code	6001275
Hospital Revenue Code	250
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$131.38
Rate for Payer: Aetna Commercial	$99.85
Rate for Payer: Aetna Medicare Advantage	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.01
Rate for Payer: Cigna Commercial	$131.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.83
Rate for Payer: Oxford Commercial	$52.55
Rate for Payer: Qualcare PPO/HMO/WC	$39.42
Rate for Payer: UnitedHealthcare Commercial	$52.55
Rate for Payer: UnitedHealthcare Community & State	$6.33
Rate for Payer: Wellpoint Medicaid Managed Care	$6.96

CLONIDINE HCL PATCH 0.3MG

Facility

$518.31

Service Code	NDC 597003334
Hospital Charge Code	6001283
Hospital Revenue Code	250
Min. Negotiated Rate	$77.75
Max. Negotiated Rate	$77.75
Rate for Payer: Qualcare PPO/HMO/WC	$77.75

CLONIDINE HCL PATCH 0.3MG

Facility

$518.31

Service Code	NDC 597003334
Hospital Charge Code	6001283
Hospital Revenue Code	250
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$259.15
Rate for Payer: Aetna Commercial	$196.96
Rate for Payer: Aetna Medicare Advantage	$155.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.17
Rate for Payer: Cigna Commercial	$259.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.49
Rate for Payer: Oxford Commercial	$103.66
Rate for Payer: Qualcare PPO/HMO/WC	$77.75
Rate for Payer: UnitedHealthcare Commercial	$103.66
Rate for Payer: UnitedHealthcare Community & State	$12.49
Rate for Payer: Wellpoint Medicaid Managed Care	$13.74

CLONIDINE TAB 0.3MG

Facility

$3.85

Hospital Charge Code	60627626
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

CLONIDINE TAB 0.3MG

Facility

$3.85

Hospital Charge Code	60627626
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

CLOPIDOGREL 75 MG TAB

Facility

$26.80

Service Code	NDC 63653117103
Hospital Charge Code	60629140
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.04
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

Know your out-of-pocket cost for care.

All Charges