St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CLONAZEPAM 0.5 MG PO TABS

Facility

$0.75

Service Code	NDC 1672913600
Hospital Charge Code	1672913600
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

CLONAZEPAM 1 MG PO TABS

Facility

$0.63

Service Code	NDC 0904772861
Hospital Charge Code	0904772861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31

CLONAZEPAM 1 MG PO TABS

Facility

$0.86

Service Code	NDC 1672913700
Hospital Charge Code	1672913700
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43

CLONAZEPAM 1 MG PO TABS

Facility

$0.63

Service Code	NDC 0904772861
Hospital Charge Code	0904772861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.43
Rate for Payer: EmblemHealth Commercial	$0.31
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.41

CLONAZEPAM 1 MG PO TABS

Facility

$0.86

Service Code	NDC 1672913700
Hospital Charge Code	1672913700
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.43
Rate for Payer: Aetna Government	$0.43
Rate for Payer: Brighton Health Commercial	$0.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: EmblemHealth Commercial	$0.43
Rate for Payer: Group Health Inc Commercial	$0.43
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43
Rate for Payer: Hamaspik Choice Inc Medicare	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.56

CLONIDINE 0.1 MG/24HR TD PTWK

Facility

$33.16

Service Code	NDC 5186245301
Hospital Charge Code	5186245301
Hospital Revenue Code	250
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$16.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.58

CLONIDINE 0.1 MG/24HR TD PTWK

Facility

$33.12

Service Code	NDC 0591350804
Hospital Charge Code	0591350804
Hospital Revenue Code	250
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$16.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56

CLONIDINE 0.1 MG/24HR TD PTWK

Facility

$33.16

Service Code	NDC 5186245301
Hospital Charge Code	5186245301
Hospital Revenue Code	250
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$26.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.58
Rate for Payer: Aetna Government	$16.58
Rate for Payer: Brighton Health Commercial	$24.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.55
Rate for Payer: EmblemHealth Commercial	$16.58
Rate for Payer: Group Health Inc Commercial	$16.58
Rate for Payer: Group Health Inc Medicare	$11.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.58
Rate for Payer: Hamaspik Choice Inc Medicare	$16.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.55

CLONIDINE 0.1 MG/24HR TD PTWK

Facility

$33.12

Service Code	NDC 0591350804
Hospital Charge Code	0591350804
Hospital Revenue Code	250
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$26.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.56
Rate for Payer: Aetna Government	$16.56
Rate for Payer: Brighton Health Commercial	$24.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.52
Rate for Payer: EmblemHealth Commercial	$16.56
Rate for Payer: Group Health Inc Commercial	$16.56
Rate for Payer: Group Health Inc Medicare	$11.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56
Rate for Payer: Hamaspik Choice Inc Medicare	$16.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.53

CLONIDINE 0.1 MG/24HR TD PTWK

Facility

$78.28

Service Code	NDC 5281761004
Hospital Charge Code	5281761004
Hospital Revenue Code	250
Min. Negotiated Rate	$39.14
Max. Negotiated Rate	$39.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.14

CLONIDINE 0.1 MG/24HR TD PTWK

Facility

$33.12

Service Code	NDC 0378087199
Hospital Charge Code	0378087199
Hospital Revenue Code	250
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$16.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56

CLONIDINE 0.1 MG/24HR TD PTWK

Facility

$33.12

Service Code	NDC 0378087199
Hospital Charge Code	0378087199
Hospital Revenue Code	250
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$26.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.56
Rate for Payer: Aetna Government	$16.56
Rate for Payer: Brighton Health Commercial	$24.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.52
Rate for Payer: EmblemHealth Commercial	$16.56
Rate for Payer: Group Health Inc Commercial	$16.56
Rate for Payer: Group Health Inc Medicare	$11.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56
Rate for Payer: Hamaspik Choice Inc Medicare	$16.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.53

CLONIDINE 0.1 MG/24HR TD PTWK

Facility

$78.28

Service Code	NDC 5281761004
Hospital Charge Code	5281761004
Hospital Revenue Code	250
Min. Negotiated Rate	$27.40
Max. Negotiated Rate	$62.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.14
Rate for Payer: Aetna Government	$39.14
Rate for Payer: Brighton Health Commercial	$58.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.23
Rate for Payer: EmblemHealth Commercial	$39.14
Rate for Payer: Group Health Inc Commercial	$39.14
Rate for Payer: Group Health Inc Medicare	$27.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.14
Rate for Payer: Hamaspik Choice Inc Medicare	$39.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.88

CLONIDINE 0.2 MG/24HR TD PTWK

Facility

$55.77

Service Code	NDC 0378087299
Hospital Charge Code	0378087299
Hospital Revenue Code	250
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$44.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.88
Rate for Payer: Aetna Government	$27.88
Rate for Payer: Brighton Health Commercial	$41.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.92
Rate for Payer: EmblemHealth Commercial	$27.88
Rate for Payer: Group Health Inc Commercial	$27.88
Rate for Payer: Group Health Inc Medicare	$19.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.88
Rate for Payer: Hamaspik Choice Inc Medicare	$27.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.25

CLONIDINE 0.2 MG/24HR TD PTWK

Facility

$22.33

Service Code	NDC 7590702411
Hospital Charge Code	7590702411
Hospital Revenue Code	250
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$11.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.17

CLONIDINE 0.2 MG/24HR TD PTWK

Facility

$55.77

Service Code	NDC 0378087299
Hospital Charge Code	0378087299
Hospital Revenue Code	250
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$27.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.88

CLONIDINE 0.2 MG/24HR TD PTWK

Facility

$22.33

Service Code	NDC 7590702411
Hospital Charge Code	7590702411
Hospital Revenue Code	250
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$17.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.17
Rate for Payer: Aetna Government	$11.17
Rate for Payer: Brighton Health Commercial	$16.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.19
Rate for Payer: EmblemHealth Commercial	$11.17
Rate for Payer: Group Health Inc Commercial	$11.17
Rate for Payer: Group Health Inc Medicare	$7.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.17
Rate for Payer: Hamaspik Choice Inc Medicare	$11.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.52

CLONIDINE 0.3 MG/24HR TD PTWK

Facility

$77.36

Service Code	NDC 0378087399
Hospital Charge Code	0378087399
Hospital Revenue Code	250
Min. Negotiated Rate	$38.68
Max. Negotiated Rate	$38.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.68

CLONIDINE 0.3 MG/24HR TD PTWK

Facility

$77.45

Service Code	NDC 5186245501
Hospital Charge Code	5186245501
Hospital Revenue Code	250
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$38.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.72

CLONIDINE 0.3 MG/24HR TD PTWK

Facility

$77.36

Service Code	NDC 0378087399
Hospital Charge Code	0378087399
Hospital Revenue Code	250
Min. Negotiated Rate	$27.08
Max. Negotiated Rate	$61.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.68
Rate for Payer: Aetna Government	$38.68
Rate for Payer: Brighton Health Commercial	$58.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.60
Rate for Payer: EmblemHealth Commercial	$38.68
Rate for Payer: Group Health Inc Commercial	$38.68
Rate for Payer: Group Health Inc Medicare	$27.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.68
Rate for Payer: Hamaspik Choice Inc Medicare	$38.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.28

CLONIDINE 0.3 MG/24HR TD PTWK

Facility

$77.45

Service Code	NDC 5186245501
Hospital Charge Code	5186245501
Hospital Revenue Code	250
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$61.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.72
Rate for Payer: Aetna Government	$38.72
Rate for Payer: Brighton Health Commercial	$58.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.66
Rate for Payer: EmblemHealth Commercial	$38.72
Rate for Payer: Group Health Inc Commercial	$38.72
Rate for Payer: Group Health Inc Medicare	$27.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.72
Rate for Payer: Hamaspik Choice Inc Medicare	$38.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.34

CLONIDINE HCL 0.1 MG PO TABS

Facility

$0.26

Service Code	NDC 5281718010
Hospital Charge Code	5281718010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

CLONIDINE HCL 0.1 MG PO TABS

Facility

$0.21

Service Code	NDC 5281718000
Hospital Charge Code	5281718000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

CLONIDINE HCL 0.1 MG PO TABS

Facility

$0.21

Service Code	NDC 5281718000
Hospital Charge Code	5281718000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

CLONIDINE HCL 0.1 MG PO TABS

Facility

$0.37

Service Code	NDC 5026819211
Hospital Charge Code	5026819211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

Know your out-of-pocket cost for care.

All Charges