Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE

Facility

$47.35

Hospital Charge Code	270656758
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$9.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$9.47
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

LIDOCAINE

Facility

$47.35

Hospital Charge Code	270656758
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

LIDOCAINE 1% 50 ML SOL

Facility

$10.18

Service Code	NDC 409427602
Hospital Charge Code	60627570
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.53

LIDOCAINE 1% 50 ML SOL

Facility

$10.18

Service Code	NDC 409427602
Hospital Charge Code	60627570
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.09
Rate for Payer: Aetna Commercial	$3.87
Rate for Payer: Aetna Medicare Advantage	$3.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.60
Rate for Payer: Cigna Commercial	$5.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.05
Rate for Payer: Oxford Commercial	$2.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.53
Rate for Payer: UnitedHealthcare Commercial	$2.04
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

LIDOCAINE 1.5%EPI 1 2 INJ 5ML

Facility

$18.02

Service Code	NDC 409120901
Hospital Charge Code	606390202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.01
Rate for Payer: Aetna Commercial	$6.85
Rate for Payer: Aetna Medicare Advantage	$5.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.60
Rate for Payer: Cigna Commercial	$9.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

LIDOCAINE 1.5%EPI 1 2 INJ 5ML

Facility

$18.02

Service Code	NDC 409120901
Hospital Charge Code	606390202
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

LIDOCAINE 1% ABBOJECT 5ML

Facility

$59.83

Service Code	NDC 409490434
Hospital Charge Code	6063943311
Hospital Revenue Code	250
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$8.97

LIDOCAINE 1% ABBOJECT 5ML

Facility

$59.83

Service Code	NDC 409490434
Hospital Charge Code	6063943311
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$29.91
Rate for Payer: Aetna Commercial	$22.74
Rate for Payer: Aetna Medicare Advantage	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.26
Rate for Payer: Cigna Commercial	$29.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.95
Rate for Payer: Oxford Commercial	$11.97
Rate for Payer: Qualcare PPO/HMO/WC	$8.97
Rate for Payer: UnitedHealthcare Commercial	$11.97
Rate for Payer: UnitedHealthcare Community & State	$1.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

LIDOCAINE/1GM/DEXTROSE

Facility

$66.00

Hospital Charge Code	60634674
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

LIDOCAINE/1GM/DEXTROSE

Facility

$66.00

Hospital Charge Code	60634674
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

LIDOCAINE 1% PF 5 ML AMP

Facility

$9.18

Service Code	NDC 409471302
Hospital Charge Code	606350966
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.59
Rate for Payer: Aetna Commercial	$3.49
Rate for Payer: Aetna Medicare Advantage	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.34
Rate for Payer: Cigna Commercial	$4.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.38
Rate for Payer: UnitedHealthcare Commercial	$1.84
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

LIDOCAINE 1% PF 5 ML AMP

Facility

$9.18

Service Code	NDC 409471302
Hospital Charge Code	606350966
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.38

LIDOCAINE 1% SOL

Facility

$24.12

Service Code	NDC 409427001
Hospital Charge Code	60629316
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

LIDOCAINE 1% SOL

Facility

$24.12

Service Code	NDC 409427001
Hospital Charge Code	60629316
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$9.17
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$12.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.24
Rate for Payer: Oxford Commercial	$4.82
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

LIDOCAINE1%WEPI 1,200,000 10ML

Facility

$59.36

Service Code	NDC 63323048717
Hospital Charge Code	606390272
Hospital Revenue Code	250
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$8.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.90

LIDOCAINE1%WEPI 1,200,000 10ML

Facility

$59.36

Service Code	NDC 63323048717
Hospital Charge Code	606390272
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$29.68
Rate for Payer: Aetna Commercial	$22.56
Rate for Payer: Aetna Medicare Advantage	$17.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.14
Rate for Payer: Cigna Commercial	$29.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.81
Rate for Payer: Oxford Commercial	$11.87
Rate for Payer: Qualcare PPO/HMO/WC	$8.90
Rate for Payer: UnitedHealthcare Commercial	$11.87
Rate for Payer: UnitedHealthcare Community & State	$1.43
Rate for Payer: Wellpoint Medicaid Managed Care	$1.57

LIDOCAINE 2% 25G 5/8 SYR

Facility

$8.00

Hospital Charge Code	60635011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

LIDOCAINE 2% 25G 5/8 SYR

Facility

$8.00

Hospital Charge Code	60635011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

LIDOCAINE 2% 5ML INJ

Facility

$16.88

Service Code	NDC 63323020805
Hospital Charge Code	606350950
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

LIDOCAINE 2% 5ML INJ

Facility

$16.88

Service Code	NDC 63323020805
Hospital Charge Code	606350950
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.06
Rate for Payer: Oxford Commercial	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.38
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

LIDOCAINE 2.5% OINT

Facility

$2,613.87

Service Code	NDC 45861006130
Hospital Charge Code	60628416
Hospital Revenue Code	250
Min. Negotiated Rate	$62.99
Max. Negotiated Rate	$1,306.93
Rate for Payer: Aetna Commercial	$993.27
Rate for Payer: Aetna Medicare Advantage	$784.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.54
Rate for Payer: Cigna Commercial	$1,306.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.16
Rate for Payer: Oxford Commercial	$522.77
Rate for Payer: Qualcare PPO/HMO/WC	$392.08
Rate for Payer: UnitedHealthcare Commercial	$522.77
Rate for Payer: UnitedHealthcare Community & State	$62.99
Rate for Payer: Wellpoint Medicaid Managed Care	$69.27

LIDOCAINE 2.5% OINT

Facility

$2,613.87

Service Code	NDC 45861006130
Hospital Charge Code	60628416
Hospital Revenue Code	250
Min. Negotiated Rate	$392.08
Max. Negotiated Rate	$392.08
Rate for Payer: Qualcare PPO/HMO/WC	$392.08

LIDOCAINE/2GM/DEXTROSE

Facility

$80.00

Hospital Charge Code	60634675
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

LIDOCAINE/2GM/DEXTROSE

Facility

$80.00

Hospital Charge Code	60634675
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

LIDOCAINE 2% PF 2ML

Facility

$30.15

Service Code	NDC 55150016402
Hospital Charge Code	606390173
Hospital Revenue Code	250
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

Know your out-of-pocket cost for care.

All Charges