Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CLONAZEPAM 0.5 MG TAB

Facility

$5.36

Service Code	NDC 51079088120
Hospital Charge Code	6011126
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

CLONAZEPAM 0.5 MG TAB

Facility

$5.36

Service Code	NDC 51079088120
Hospital Charge Code	6011126
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

CLONAZEPAM 1 MG TAB

Facility

$6.10

Service Code	NDC 51079088221
Hospital Charge Code	60627740
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

CLONAZEPAM 1 MG TAB

Facility

$6.10

Service Code	NDC 51079088221
Hospital Charge Code	60627740
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare Advantage	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.56
Rate for Payer: Cigna Commercial	$3.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.59
Rate for Payer: Oxford Commercial	$1.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.92
Rate for Payer: UnitedHealthcare Commercial	$1.22
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

CLONAZEPAM 1MG TAB RAPDIS

Facility

$9.92

Service Code	NDC 49884030902
Hospital Charge Code	606390299
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.49

CLONAZEPAM 1MG TAB RAPDIS

Facility

$9.92

Service Code	NDC 49884030902
Hospital Charge Code	606390299
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.96
Rate for Payer: Aetna Commercial	$3.77
Rate for Payer: Aetna Medicare Advantage	$2.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.53
Rate for Payer: Cigna Commercial	$4.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.49
Rate for Payer: UnitedHealthcare Commercial	$1.98
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

CLONAZEPAM (KLONOPIN)

Facility

$180.00

Service Code	HCPCS 80346
Hospital Charge Code	38473121
Hospital Revenue Code	301
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$68.40
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	$46.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

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	$5.16
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.03
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	$47.23
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.16

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	$0.60
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	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CLONIDINE 0.1MG TAB(CATAPRES)

Facility

$4.00

Hospital Charge Code	83652557
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

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 0.2 MG TAB

Facility

$4.00

Service Code	NDC 51079030020
Hospital Charge Code	60627625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
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/0.3MG/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/0.3MG/TAB

Facility

$4.00

Service Code	NDC 904565861
Hospital Charge Code	60632719
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CLONIDINE HCL PATCH 0.1MG

Facility

$221.90

Service Code	NDC 378087199
Hospital Charge Code	6001267
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
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	$57.69
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	$7.01
Rate for Payer: Wellpoint Medicaid Managed Care	$6.30

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	$7.46
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	$68.32
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	$8.30
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

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 0.3MG

Facility

$518.31

Service Code	NDC 597003334
Hospital Charge Code	6001283
Hospital Revenue Code	250
Min. Negotiated Rate	$14.72
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	$134.76
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	$16.38
Rate for Payer: Wellpoint Medicaid Managed Care	$14.72

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

CLOPIDOGREL 75 MG TAB

Facility

$26.80

Service Code	NDC 63653117103
Hospital Charge Code	60629140
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
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	$6.97
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	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

Know your out-of-pocket cost for care.

All Charges