Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLONAZEPAM (KLONOPIN)

Facility

$180.00

Service Code	HCPCS 80346
Hospital Charge Code	38473121
Hospital Revenue Code	301
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$114.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

CLONAZEPAM (KLONOPIN)

Facility

$180.00

Service Code	HCPCS 80346
Hospital Charge Code	38473121
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

CLONAZEPAM, (KLONOPIN) SERUM

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007309
Hospital Revenue Code	301
Min. Negotiated Rate	$23.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.49
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00

CLONAZEPAM, (KLONOPIN) SERUM

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007309
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CLONIDINE 0.1 MG TAB

Facility

$4.00

Service Code	NDC 51079029920
Hospital Charge Code	60627624
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

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/0.1MG/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

Facility

$3.00

Hospital Charge Code	60632720
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

CLONIDINE/0.1MG/TAB

Facility

$4.00

Hospital Charge Code	60632717
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

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(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	$0.60
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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

CLONIDINE 0.2 MG TAB

Facility

$4.00

Service Code	NDC 51079030020
Hospital Charge Code	60627625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

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

$4.00

Hospital Charge Code	60632718
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

CLONIDINE/0.2MG/TAB

Facility

$3.00

Hospital Charge Code	60632721
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

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

$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	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

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	$28.85
Max. Negotiated Rate	$110.95
Rate for Payer: Aetna Commercial	$66.57
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	$28.85
Rate for Payer: Oxford Commercial	$110.95
Rate for Payer: Qualcare PPO/HMO/WC	$33.28
Rate for Payer: UnitedHealthcare Commercial	$110.95

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	$34.16
Max. Negotiated Rate	$131.38
Rate for Payer: Aetna Commercial	$78.83
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	$34.16
Rate for Payer: Oxford Commercial	$131.38
Rate for Payer: Qualcare PPO/HMO/WC	$39.42
Rate for Payer: UnitedHealthcare Commercial	$131.38

CLONIDINE HCL PATCH 0.3MG

Facility

$518.31

Service Code	NDC 597003334
Hospital Charge Code	6001283
Hospital Revenue Code	250
Min. Negotiated Rate	$67.38
Max. Negotiated Rate	$259.15
Rate for Payer: Aetna Commercial	$155.49
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	$67.38
Rate for Payer: Oxford Commercial	$259.15
Rate for Payer: Qualcare PPO/HMO/WC	$77.75
Rate for Payer: UnitedHealthcare Commercial	$259.15

Know your out-of-pocket cost for care.

All Charges