Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

Facility

$26.80

Service Code	NDC 51862-454-04
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$14.74
Max. Negotiated Rate	$21.44
Rate for Payer: Cash Price	$12.06
Rate for Payer: Cigna of CA HMO/PPO	$21.44
Rate for Payer: Health Smart Auto/Commercial	$16.08
Rate for Payer: LLUH Dept of Risk Management WC	$14.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.10

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

Facility

$53.54

Service Code	NDC 0591-3509-54
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$40.16
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	$24.09
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	$29.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.16

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

Facility

$53.54

Service Code	NDC 0591-3509-04
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$42.83
Rate for Payer: Cash Price	$24.09
Rate for Payer: Cigna of CA HMO/PPO	$42.83
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.16

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

Facility

$53.54

Service Code	NDC 0378-0872-16
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$40.16
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	$24.09
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	$29.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.16

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

Facility

$26.80

Service Code	NDC 51862-454-01
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$14.74
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.08
Rate for Payer: Aetna of CA Government/Medicare	$16.08
Rate for Payer: Cash Price	$12.06
Rate for Payer: Health Smart Auto/Commercial	$16.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.08
Rate for Payer: LLUH Dept of Risk Management WC	$14.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.10

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

Facility

$146.61

Service Code	NDC 0597-0032-34
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$80.64
Max. Negotiated Rate	$109.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$87.97
Rate for Payer: Aetna of CA Government/Medicare	$87.97
Rate for Payer: Cash Price	$65.97
Rate for Payer: Health Smart Auto/Commercial	$87.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$87.97
Rate for Payer: LLUH Dept of Risk Management WC	$80.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$109.96

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

Facility

$53.54

Service Code	NDC 0591-3509-04
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$40.16
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	$24.09
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	$29.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.16

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

Facility

$53.54

Service Code	NDC 0591-3509-54
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$42.83
Rate for Payer: Cash Price	$24.09
Rate for Payer: Cigna of CA HMO/PPO	$42.83
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.16

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

Facility

$146.61

Service Code	NDC 0597-0032-34
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$80.64
Max. Negotiated Rate	$117.29
Rate for Payer: Cash Price	$65.97
Rate for Payer: Cigna of CA HMO/PPO	$117.29
Rate for Payer: Health Smart Auto/Commercial	$87.97
Rate for Payer: LLUH Dept of Risk Management WC	$80.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$109.96

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

Facility

$53.54

Service Code	NDC 0378-0872-16
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$42.83
Rate for Payer: Cash Price	$24.09
Rate for Payer: Cigna of CA HMO/PPO	$42.83
Rate for Payer: Health Smart Auto/Commercial	$32.12
Rate for Payer: LLUH Dept of Risk Management WC	$29.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$40.16

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

Facility

$26.80

Service Code	NDC 51862-454-01
Hospital Charge Code	1743457
Hospital Revenue Code	259
Min. Negotiated Rate	$14.74
Max. Negotiated Rate	$21.44
Rate for Payer: Cash Price	$12.06
Rate for Payer: Cigna of CA HMO/PPO	$21.44
Rate for Payer: Health Smart Auto/Commercial	$16.08
Rate for Payer: LLUH Dept of Risk Management WC	$14.74
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.10

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

Facility

$203.38

Service Code	NDC 0597-0033-34
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$111.86
Max. Negotiated Rate	$152.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$122.03
Rate for Payer: Aetna of CA Government/Medicare	$122.03
Rate for Payer: Cash Price	$91.52
Rate for Payer: Health Smart Auto/Commercial	$122.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$122.03
Rate for Payer: LLUH Dept of Risk Management WC	$111.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.54

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

Facility

$203.38

Service Code	NDC 0597-0033-34
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$111.86
Max. Negotiated Rate	$162.70
Rate for Payer: Cash Price	$91.52
Rate for Payer: Cigna of CA HMO/PPO	$162.70
Rate for Payer: Health Smart Auto/Commercial	$122.03
Rate for Payer: LLUH Dept of Risk Management WC	$111.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.54

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

Facility

$74.27

Service Code	NDC 0591-3510-04
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$59.42
Rate for Payer: Cash Price	$33.42
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$55.70

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

Facility

$37.18

Service Code	NDC 51862-455-04
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$29.74
Rate for Payer: Cash Price	$16.73
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$27.88

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

Facility

$74.27

Service Code	NDC 0591-3510-54
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$55.70
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	$33.42
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 Beech St/Commercial/PHCS	$55.70

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

Facility

$37.18

Service Code	NDC 51862-455-01
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$29.74
Rate for Payer: Cash Price	$16.73
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$27.88

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

Facility

$37.18

Service Code	NDC 51862-455-04
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$27.88
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	$16.73
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 Beech St/Commercial/PHCS	$27.88

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

Facility

$74.27

Service Code	NDC 0591-3510-04
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$55.70
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	$33.42
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 Beech St/Commercial/PHCS	$55.70

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

Facility

$37.18

Service Code	NDC 51862-455-01
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$27.88
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	$16.73
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 Beech St/Commercial/PHCS	$27.88

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

Facility

$74.27

Service Code	NDC 0591-3510-54
Hospital Charge Code	1743458
Hospital Revenue Code	259
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$59.42
Rate for Payer: Cash Price	$33.42
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$55.70

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$0.05

Service Code	NDC 62332-054-31
Hospital Charge Code	1712037
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.04

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$0.37

Service Code	NDC 60687-113-01
Hospital Charge Code	1712037
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.28
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	$0.17
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 Beech St/Commercial/PHCS	$0.28

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$0.37

Service Code	NDC 60687-113-11
Hospital Charge Code	1712037
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.28
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	$0.17
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 Beech St/Commercial/PHCS	$0.28

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$0.05

Service Code	NDC 68001-237-00
Hospital Charge Code	1712037
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	$0.02
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 Beech St/Commercial/PHCS	$0.04

Know your out-of-pocket cost for care.

All Charges