Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

OP

$53.53

Service Code	NDC 0378-0872-99
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$42.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.12
Rate for Payer: Aetna of CA Government/Medicare	$32.12
Rate for Payer: Cash Price	$29.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.82
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.44
Rate for Payer: Multiplan Commercial	$40.15

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

OP

$16.61

Service Code	NDC 52817-611-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$13.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.97
Rate for Payer: Aetna of CA Government/Medicare	$9.97
Rate for Payer: Cash Price	$9.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.29
Rate for Payer: Health Smart Auto/Commercial	$9.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.97
Rate for Payer: LLUH Dept of Risk Management WC	$9.14
Rate for Payer: Multiplan Commercial	$12.46

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

IP

$53.53

Service Code	NDC 0591-3509-54
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$42.82
Rate for Payer: Cash Price	$29.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.82
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.44
Rate for Payer: Multiplan Commercial	$40.15

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

IP

$53.53

Service Code	NDC 0378-0872-99
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$42.82
Rate for Payer: Cash Price	$29.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.82
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.44
Rate for Payer: Multiplan Commercial	$40.15

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

OP

$53.53

Service Code	NDC 0378-0872-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$42.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.12
Rate for Payer: Aetna of CA Government/Medicare	$32.12
Rate for Payer: Cash Price	$29.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.82
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.44
Rate for Payer: Multiplan Commercial	$40.15

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

OP

$53.53

Service Code	NDC 0591-3509-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$42.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.12
Rate for Payer: Aetna of CA Government/Medicare	$32.12
Rate for Payer: Cash Price	$29.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.82
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.44
Rate for Payer: Multiplan Commercial	$40.15

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

IP

$53.53

Service Code	NDC 0378-0872-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$42.82
Rate for Payer: Cash Price	$29.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.82
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.44
Rate for Payer: Multiplan Commercial	$40.15

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

IP

$53.53

Service Code	NDC 0591-3509-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$42.82
Rate for Payer: Cash Price	$29.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.82
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.44
Rate for Payer: Multiplan Commercial	$40.15

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

IP

$16.61

Service Code	NDC 52817-611-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$13.29
Rate for Payer: Cash Price	$9.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.29
Rate for Payer: Health Smart Auto/Commercial	$9.97
Rate for Payer: LLUH Dept of Risk Management WC	$9.14
Rate for Payer: Multiplan Commercial	$12.46

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]

Facility

OP

$53.53

Service Code	NDC 0591-3509-54
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$42.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.12
Rate for Payer: Aetna of CA Government/Medicare	$32.12
Rate for Payer: Cash Price	$29.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.82
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.44
Rate for Payer: Multiplan Commercial	$40.15

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]

Facility

OP

$37.18

Service Code	NDC 51862-455-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$29.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.31
Rate for Payer: Aetna of CA Government/Medicare	$22.31
Rate for Payer: Cash Price	$20.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.74
Rate for Payer: Health Smart Auto/Commercial	$22.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.31
Rate for Payer: LLUH Dept of Risk Management WC	$20.45
Rate for Payer: Multiplan Commercial	$27.89

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]

Facility

IP

$74.27

Service Code	NDC 0591-3510-54
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$59.42
Rate for Payer: Cash Price	$40.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.42
Rate for Payer: Health Smart Auto/Commercial	$44.56
Rate for Payer: LLUH Dept of Risk Management WC	$40.85
Rate for Payer: Multiplan Commercial	$55.70

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]

Facility

IP

$74.27

Service Code	NDC 0591-3510-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$59.42
Rate for Payer: Cash Price	$40.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.42
Rate for Payer: Health Smart Auto/Commercial	$44.56
Rate for Payer: LLUH Dept of Risk Management WC	$40.85
Rate for Payer: Multiplan Commercial	$55.70

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]

Facility

IP

$37.18

Service Code	NDC 51862-455-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$29.74
Rate for Payer: Cash Price	$20.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.74
Rate for Payer: Health Smart Auto/Commercial	$22.31
Rate for Payer: LLUH Dept of Risk Management WC	$20.45
Rate for Payer: Multiplan Commercial	$27.89

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]

Facility

IP

$37.18

Service Code	NDC 51862-455-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$29.74
Rate for Payer: Cash Price	$20.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.74
Rate for Payer: Health Smart Auto/Commercial	$22.31
Rate for Payer: LLUH Dept of Risk Management WC	$20.45
Rate for Payer: Multiplan Commercial	$27.89

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]

Facility

OP

$74.27

Service Code	NDC 0591-3510-54
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$59.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$44.56
Rate for Payer: Aetna of CA Government/Medicare	$44.56
Rate for Payer: Cash Price	$40.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.42
Rate for Payer: Health Smart Auto/Commercial	$44.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$44.56
Rate for Payer: LLUH Dept of Risk Management WC	$40.85
Rate for Payer: Multiplan Commercial	$55.70

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]

Facility

OP

$37.18

Service Code	NDC 51862-455-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$29.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.31
Rate for Payer: Aetna of CA Government/Medicare	$22.31
Rate for Payer: Cash Price	$20.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.74
Rate for Payer: Health Smart Auto/Commercial	$22.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.31
Rate for Payer: LLUH Dept of Risk Management WC	$20.45
Rate for Payer: Multiplan Commercial	$27.89

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [27507]

Facility

OP

$74.27

Service Code	NDC 0591-3510-04
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$59.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$44.56
Rate for Payer: Aetna of CA Government/Medicare	$44.56
Rate for Payer: Cash Price	$40.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.42
Rate for Payer: Health Smart Auto/Commercial	$44.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$44.56
Rate for Payer: LLUH Dept of Risk Management WC	$40.85
Rate for Payer: Multiplan Commercial	$55.70

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

IP

$0.36

Service Code	NDC 60687-113-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Commercial	$0.27

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

IP

$0.05

Service Code	NDC 62332-054-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.04

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

OP

$0.36

Service Code	NDC 60687-113-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Commercial	$0.27

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

IP

$0.05

Service Code	NDC 68001-237-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.04

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

OP

$0.05

Service Code	NDC 68001-237-00
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.04

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

IP

$0.36

Service Code	NDC 60687-113-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.29
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Commercial	$0.27

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

OP

$0.05

Service Code	NDC 68001-237-03
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.04

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